Business (For- and Not-for-Profit)

Healthy Incentives Pilot Evaluation

OMB: 0584-0561

IC ID: 197619

Documents and Forms
Document Name
Document Type
Other-Round 1 Participating Independ
Other-Round 2 Participating Independ
Other-Round 1 Participating Chain St
Other-Round 2 Participating Chain St
Other-Non-Participating Store Survey
Other-Withdrawn Store Survey
Other-Newly Participating Store Surv
Other-Store Observation Form
Other-Round 1 EBT Contractor (ACS) I
Other-Round 2 EBT Contractor (ACS) I
Other-Round 3 EBT Contractor (ACS) I
Other-Round 1 Integrated Retailers�
Other-Round 2 Integrated Retailers�
Other-Round 3 Integrated Retailers�
Other-Round 1 Third Party Processors
Other-Round 2 Third Party Processors
Other-Round 3Third Party Processors
Other-Round 1 Community Based Organi
Other-Round 2 Community Based Organi
Other-Round 3 Community Based Organi
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Business (For- and Not-for-Profit)
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted 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 Retailers� Interview Guide Appendix F16.docm No   Paper Only
Other-Round 2 Integrated Retailers� Interview Guide Appendix F17.docm No   Paper Only
Other-Round 3 Integrated Retailers� 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

Income Security Food and Nutrition Assistance

 

187 125
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 187 0 187 0 0 0
Annual IC Time Burden (Hours) 120 0 120 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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