Document Name Document Type
Appendix A Impact Evaluation Data Collecting Instrument MSUE 3 16 11.doc Other-Questionnaire - Michigan
Appendix A. Impact Evaluation Data Collecting Instrument UKCES 3.16.11.doc Other-Questionnaire - KY
Appendix A. Impact Evaluation Data Collecting Instruments INN 3.16.11.doc Other-Questionnaire - PA
APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 1.docx Other-Survey Instruments for the Iow
APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 2.docx Other-Survey: Instruments for the Io
APPENDIX A. Data Collection Instruments for Impact Evaluation INN English Part 3 1-3-2011 PRAB comments.docx Other-Survey: Instruments for the Io
APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 4.docx Other-Survey: Instruments for the Io
APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 5.docx Other-Survey: Instruments for the Io
Postcard_NewYear2012.pdf Other-NEW Postcard
APPENDIX H. Cover Letters, Recruitment Letters and other St SLO 2.1.11.docx APPENDIX H. Households Cover Letters, Recruitment Letters and other IC Document
APPENDIX E. Statistical Methods for Impact Evaluation_final.docx APPENDIX E. Statistical Methods for Impact Evaluation IC Document
APPENDIX F. Data Collection Methods for Impact Evaluation_f.docx APPENDIX F. Data Collection Methods for Impact Evaluation IC Document
APPENDIX H. Cover Letters, Recruitment Letters and other St SLO 2.1.11.docx Appendix H - Cover Letters, Recruitment Letters and other IC Document
APPENDIX E. Statistical Methods for Impact Evaluation_final.docx APPENDIX E. Statistical Methods for Impact Evaluation IC Document
APPENDIX F. Data Collection Methods for Impact Evaluation_f.docx APPENDIX F. Data Collection Methods for Impact Evaluation IC Document
OMB_Memo_PostCard (2) revised dec 2011 (2).doc Change Justification Memo IC Document
0554 SNAP Edu Wave II burden estimate table revised 2-1-12.xlsx Revised Burden Estimate Table IC Document
0554 Non-responses for SNAP Edu Wave II burden estimate table revised 2-1-12.xlsx Non Respondent Burden IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Impact Evaluation Instruments - Households	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-NEW Postcard	Postcard_NewYear2012.pdf	No	Paper Only
Other-Questionnaire - Michigan	Appendix A Impact Evaluation Data Collecting Instrument MSUE 3 16 11.doc	No	Paper Only
Other-Questionnaire - KY	Appendix A. Impact Evaluation Data Collecting Instrument UKCES 3.16.11.doc	No	Paper Only
Other-Questionnaire - PA	Appendix A. Impact Evaluation Data Collecting Instruments INN 3.16.11.doc	No	Paper Only
Other-Survey Instruments for the Iowa Nutrition Network Impact Evaluation�Spanish Version	APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 1.docx	No	Paper Only
Other-Survey: Instruments for the Iowa Nutrition Network Impact Evaluation�Spanish Version	APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 2.docx	No	Paper Only
Other-Survey: Instruments for the Iowa Nutrition Network Impact Evaluation�Spanish Version	APPENDIX A. Data Collection Instruments for Impact Evaluation INN English Part 3 1-3-2011 PRAB comments.docx	No	Paper Only
Other-Survey: Instruments for the Iowa Nutrition Network Impact Evaluation�Spanish Version	APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 4.docx	No	Paper Only
Other-Survey: Instruments for the Iowa Nutrition Network Impact Evaluation�Spanish Version	APPENDIX A. Data Collection Instruments for Impact Evaluation INN Spanish Part 5.docx	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: 1,928	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,752	-739	7,491
Annual IC Time Burden (Hours)	1,640	86	1,554
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
APPENDIX H. Households Cover Letters, Recruitment Letters and other	APPENDIX H. Cover Letters, Recruitment Letters and other St SLO 2.1.11.docx	03/02/2011
APPENDIX E. Statistical Methods for Impact Evaluation	APPENDIX E. Statistical Methods for Impact Evaluation_final.docx	03/03/2011
APPENDIX F. Data Collection Methods for Impact Evaluation	APPENDIX F. Data Collection Methods for Impact Evaluation_f.docx	03/03/2011
Appendix H - Cover Letters, Recruitment Letters and other	APPENDIX H. Cover Letters, Recruitment Letters and other St SLO 2.1.11.docx	06/09/2011
APPENDIX E. Statistical Methods for Impact Evaluation	APPENDIX E. Statistical Methods for Impact Evaluation_final.docx	06/09/2011
APPENDIX F. Data Collection Methods for Impact Evaluation	APPENDIX F. Data Collection Methods for Impact Evaluation_f.docx	06/09/2011
Change Justification Memo	OMB_Memo_PostCard (2) revised dec 2011 (2).doc	01/13/2012
Revised Burden Estimate Table	0554 SNAP Edu Wave II burden estimate table revised 2-1-12.xlsx	02/07/2012
Non Respondent Burden	0554 Non-responses for SNAP Edu Wave II burden estimate table revised 2-1-12.xlsx	02/07/2012

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

Impact Evaluation Instruments - Households

Eval of SNAP Nutrition Edu Practices Study - Wave II

OMB: 0584-0554

IC ID: 190543

View Information Collection (IC)