Information Collection

Business (For- and Not-for-Profit)

IC 197619 under ICR 201105-0584-001 · OMB 0584-0561.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0561 can be found here:

2012-02-09 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix E1.doc	Other-Round 1 Participating Independ
Appendix E2.doc	Other-Round 2 Participating Independ
Appendix E3.doc	Other-Round 1 Participating Chain St
Appendix E4.doc	Other-Round 2 Participating Chain St
Appendix E5.doc	Other-Non-Participating Store Survey
Appendix E6.doc	Other-Withdrawn Store Survey
Appendix E7.doc	Other-Newly Participating Store Surv
Appendix E8.doc	Other-Store Observation Form
Appendix F13.docm	Other-Round 1 EBT Contractor (ACS) I
Appendix F14.docm	Other-Round 2 EBT Contractor (ACS) I
Appendix F15.docm	Other-Round 3 EBT Contractor (ACS) I
Appendix F16.docm	Other-Round 1 Integrated Retailers�
Appendix F17.docm	Other-Round 2 Integrated Retailers�
Appendix F18.docm	Other-Round 3 Integrated Retailers�
Appendix F19.docm	Other-Round 1 Third Party Processors
Appendix F20.docm	Other-Round 2 Third Party Processors
Appendix F21.docm	Other-Round 3Third Party Processors
Appendix F22.docm	Other-Round 1 Community Based Organi
Appendix F23.docm	Other-Round 2 Community Based Organi
Appendix F24.docm	Other-Round 3 Community Based Organi
Appendix E9.doc Follow-up Reminder Telephone Script	IC Document
Appendix E10.doc Retailer Telephone Notification Recruiting Script	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Business (For- and Not-for-Profit)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Round 1 EBT Contractor (ACS) Interview Guide	Appendix F13.docm	No	Paper Only
Other-Round 2 EBT Contractor (ACS) Interview Guide	Appendix F14.docm	No	Paper Only
Other-Round 3 EBT Contractor (ACS) Interview Guide	Appendix F15.docm	No	Paper Only
Other-Round 1 Integrated Retailersï¿½ Interview Guide	Appendix F16.docm	No	Paper Only
Other-Round 2 Integrated Retailersï¿½ Interview Guide	Appendix F17.docm	No	Paper Only
Other-Round 3 Integrated Retailersï¿½ Interview Guide	Appendix F18.docm	No	Paper Only
Other-Round 1 Third Party Processors (TPPs) Interview Guide	Appendix F19.docm	No	Paper Only
Other-Round 2 Third Party Processors (TPPs) Interview Guide	Appendix F20.docm	No	Paper Only
Other-Round 3Third Party Processors (TPPs) Interview Guide	Appendix F21.docm	No	Paper Only
Other-Round 1 Community Based Organization Interview Guide	Appendix F22.docm	No	Paper Only
Other-Round 2 Community Based Organization Interview Guide	Appendix F23.docm	No	Paper Only
Other-Round 3 Community Based Organization Interview Guide	Appendix F24.docm	No	Paper Only
Other-Round 1 Participating Independent Store Survey	Appendix E1.doc	No	Paper Only
Other-Round 2 Participating Independent Store Survey	Appendix E2.doc	No	Paper Only
Other-Round 1 Participating Chain Store Survey	Appendix E3.doc	No	Paper Only
Other-Round 2 Participating Chain Store Survey	Appendix E4.doc	No	Paper Only
Other-Non-Participating Store Survey	Appendix E5.doc	No	Paper Only
Other-Withdrawn Store Survey	Appendix E6.doc	No	Paper Only
Other-Newly Participating Store Survey	Appendix E7.doc	No	Paper Only
Other-Store Observation Form	Appendix E8.doc	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 187

Number of Respondents for Small Entity: 125

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	187	187
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Follow-up Reminder Telephone Script	Appendix E9.doc	05/06/2011
Retailer Telephone Notification Recruiting Script	Appendix E10.doc	05/06/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.