Information Collection

Elderly & Working Poor

IC 193210 under ICR 201107-0584-002 · OMB 0584-0558.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0558 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A Screener for Working Poor Final 10-5-2010.docx	Other-Telephone Screener
Appendix_B_Screener_for_Elderly_Fina.docx	Other-Telephone Screener
Appendix E Focus Group Discussion Protocol Final 10-5-2010.docx	Other-Focus Group Guide
Appendix I Focus Group Protocol Spanish Final 10-5-2010.docx	Other-Focus Group Guide - Spanish
Appendix F Recruitment Script Working Poor Spanish Final 10-5-2010.docx	Other-Recruitment Script Working Poo
Appendix B Screener for Elderly Final.docx	Other-Appendix B: REVISED Screener f
Appendix E Focus Group Discussion Protocol Revised.docx	Other-Appendix E: REVISED Focus Grou
Modification_protocol (2).docx	Other-REVISE Modification Protocol
Appendix C Focus Group Reminder Letter 6-10-10.docx Reminder Telephone Script	IC Document
Appendix D Focus Group Reminder Call.docx Reminder Call - Spanish	IC Document
Appendix G Focus Group Reminder Letter Spanish.docx Reminder Letter - Spanish	IC Document
Reminder Call Script With Final Comments-pretest_revised.docx REVISED Reminder Call Script for Elderly	IC Document
reminder letter with final comments-pretest_revised Reminder Letter	IC Document

IC Title:

Elderly & Working Poor

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Focus Group Guide - Spanish	Appendix I Focus Group Protocol Spanish Final 10-5-2010.docx	No	Paper Only
Other-Recruitment Script Working Poor - Spanish	Appendix F Recruitment Script Working Poor Spanish Final 10-5-2010.docx	No	Paper Only
Other-Appendix B: REVISED Screener for Elderly	Appendix B Screener for Elderly Final.docx	No	Paper Only
Other-Appendix E: REVISED Focus Group Discussion Protocol	Appendix E Focus Group Discussion Protocol Revised.docx	No	Paper Only
Other-REVISE Modification Protocol	Modification_protocol (2).docx	No	Paper Only
Other-Telephone Screener	Appendix A Screener for Working Poor Final 10-5-2010.docx	No	Paper Only
Other-Telephone Screener	Appendix_B_Screener_for_Elderly_Fina.docx	No	Paper Only
Other-Focus Group Guide	Appendix E Focus Group Discussion Protocol Final 10-5-2010.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	195	195
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Reminder Telephone Script	Appendix C Focus Group Reminder Letter 6-10-10.docx	06/10/2010
Reminder Call - Spanish	Appendix D Focus Group Reminder Call.docx	06/09/2010
Reminder Letter - Spanish	Appendix G Focus Group Reminder Letter Spanish.docx	06/10/2010
REVISED Reminder Call Script for Elderly	Reminder Call Script With Final Comments-pretest_revised.docx	07/13/2011
Reminder Letter	reminder letter with final comments-pretest_revised	07/13/2011

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