Information Collection

Parents-Minor Surveys

IC 197607 under ICR 201201-0584-006 · OMB 0584-0561.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix B1 - Round 1 Study Participant and Primary Shopper-English.doc	Other-Survey
Appendix B2 - Round 2 Study Participant and Primary Shopper-English.doc	Other-Survey
Appendix B3 - Round 3 Study Participant and Primary Shopper-English.doc	Other-Survey
Appendix B4 Round 1 Study Participant and Primary Shopper Survey-Spanish.doc	Other-Survey
Appendix B5 - Round 2 Study Participant and Primary Shopper-Spanish.doc	Other-Survey
Appendix B6 - Round 3 Study Participant and Primary Shopper-Spanish.doc	Other-Survey
Appendix C - AMPM Screenshots.doc www.ars.usda.gov/Services/docs.htm?docid=7710#what	Other-Screenshots
Appendix D1 - FG Participant Telephone Recruitment Script-English.doc	Other-D1 - Focus Group Participant T
Appendix D2 - FG Participant Consent Form-English.doc	Other-Participant Consent Form
Appendix D3- FG Protocol-English.doc	Other-Moderator Guide
Appendix D4 - FG Data Sheet-English.doc	Other-Demographics Questionnaire
Appendix D5 - FG Participant Incentive Receipt Form-English.doc	Other-Incentive Acknowledgement Rece
Attachment 5 QRE with Added Cell Question 2-2-12.docx	Other-Survey- Attachment 5 QRE with
Attachment 6 QRE with Added Cell Question Spanish 2-2-12.docx	Other-Attachment 6 QRE with Added Ce
Appendix A 1-Round 1 Advanced Letter to Study Participants-English.doc A 1-Round 1 Advanced Letter to Study Participants-English	IC Document
Appendix A 2-Round 1 Advanced Letter to Parents of Minors-English.doc A 2-Round 1 Advanced Letter to Parents of Minors-English	IC Document
Appendix A 3-Round 2 Advanced Letter to Study Participants-English.doc A 3-Round 2 Advanced Letter to Study Participants-English	IC Document
Appendix A 4-Round 2 Advanced Letter to Parents of Minors-English.doc A 4-Round 2 Advanced Letter to Parents of Minors-English	IC Document
Appendix A 5-Round 3 Advanced Letter to Study Participants-English.doc A 5-Round 3 Advanced Letter to Study Participants-English	IC Document
Appendix A 6-Round 3 Advanced Letter to Parents of Minors-English.doc A 6-Round 3 Advanced Letter to Parents of Minors-English	IC Document
Appendix A 7-Round 1Advanced Letter to Study Participants-Spanish.doc A 7-Round 1 Advanced Letter to Study Participants-Spanish	IC Document
Appendix A 8-Round 1 Advanced Letter to Parents of Minors-Spanish.doc A 8-Round 1 Advanced Letter to Parents of Minors-Spanish	IC Document
Appendix A 9-Round 2 Advanced Letter to Study Participants-Spanish.doc A 9-Round 2 Advanced Letter to Study Participants-Spanish	IC Document
Appendix A 10-Round 2 Advanced Letter to Parents of Minors-Spanish.doc A 10-Round 2 Advanced Letter to Parents of Minors-Spanish	IC Document
Appendix A 11-Round 3 Advanced Letter to Study Participants-Spanish.doc A 11-Round 3 Advanced Letter to Study Participants-Spanish	IC Document
Appendix A 12-Round 3 Advanced Letter to Parent of Minors-Spanish.doc A 12-Round 3 Advanced Letter to Parent of Minors-Spanish	IC Document
Appendix B7 - In person script-English.doc B7 - In person script-English	IC Document
Appendix B8 - Voicemail script-English.doc B8 - Voicemail script-English	IC Document
Appendix B9 - Refusal strategy and script-English.doc B9 - Refusal strategy and script-English	IC Document
Attachment 2 Round 2 Advance Letter for Minors REV 1-19-12.docx Attachment 2 Round 2 Advance Letter for Minors REV 1-19-12	IC Document
Attachment 3 Round 3 Advance Letter Rev 2-2-12.docx Attachment 3 Round 3 Advance Letter Rev 2-2-12	IC Document
Attachment 4 Round 3 Advance Letter for Minors REV 2-2-12.docx Attachment 4 Round 3 Advance Letter for Minors REV 2-2-12	IC Document
Attachment 7 Round 2 Advance Letter Spanish Rev 2-2-12.docx Attachment 7 Round 2 Advance Letter Spanish Rev 2-212	IC Document
Attachment 8 Round 2 Advance Letter for Minors Spanish Rev 2-2-12.docx Attachment 8 Round 2 Advance Letter for Minors Spanish Rev 2-2.12	IC Document
Attachment 9 Round 3 Advance Letter Spanish rev 2-2-12.docx Attachment 9 Round 3 Advance Letter Spanish rev 2-2-12	IC Document
Attachment 10 Round 3 Advance Letter for Minors Spanish rev 2-2-12.docx Attachment 10 Round 3 Advance Letter for Minors Spanish rev 2-2-12	IC Document
Attachment 1 Round 2 Advance Letter Rev2 2-2-12.docx Attachment 1 Round 2 Advance Letter Rev2 2-2-12	IC Document
Attachment 2 Round 2 Advance Letter for Minors REV 2-2-12.docx Attachment 2 Round 2 Advance Letter for Minors REV 2-2-12	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Parents-Minor Surveys

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey- Attachment 5 QRE with Added Cell Question 1-19-12	Attachment 5 QRE with Added Cell Question 2-2-12.docx		No		Paper Only
Other-Attachment 6 QRE with Added Cell Question Spanish 2-2-12	Attachment 6 QRE with Added Cell Question Spanish 2-2-12.docx		No		Paper Only
Other-Survey	Appendix B1 - Round 1 Study Participant and Primary Shopper-English.doc		No		Paper Only
Other-Survey	Appendix B2 - Round 2 Study Participant and Primary Shopper-English.doc		No		Paper Only
Other-Survey	Appendix B3 - Round 3 Study Participant and Primary Shopper-English.doc		No		Paper Only
Other-Survey	Appendix B4 Round 1 Study Participant and Primary Shopper Survey-Spanish.doc		No		Paper Only
Other-Survey	Appendix B5 - Round 2 Study Participant and Primary Shopper-Spanish.doc		No		Paper Only
Other-Survey	Appendix B6 - Round 3 Study Participant and Primary Shopper-Spanish.doc		No		Paper Only
Other-Screenshots	Appendix C - AMPM Screenshots.doc	http://www.ars.usda.gov/Services/docs.htm?docid=7710#what	Yes	Yes	Fillable Fileable
Other-D1 - Focus Group Participant Telephone Recruitment Script: English	Appendix D1 - FG Participant Telephone Recruitment Script-English.doc		No		Paper Only
Other-Participant Consent Form	Appendix D2 - FG Participant Consent Form-English.doc		No		Paper Only
Other-Moderator Guide	Appendix D3- FG Protocol-English.doc		No		Paper Only
Other-Demographics Questionnaire	Appendix D4 - FG Data Sheet-English.doc		No		Paper Only
Other-Incentive Acknowledgement Receipt	Appendix D5 - FG Participant Incentive Receipt Form-English.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: 2,915

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	5,916	5,916
Annual IC Time Burden (Hours)	4,577	4,577
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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