Parents-Minor Surveys

Healthy Incentives Pilot Evaluation

OMB: 0584-0561

IC ID: 197607

Documents and Forms
Document Name
Document Type
Other-Survey
Other-Survey
Other-Survey
Other-Survey
Other-Survey
Other-Survey
Other-Screenshots
Other-D1 - Focus Group Participant T
Other-Participant Consent Form
Other-Moderator Guide
Other-Demographics Questionnaire
Other-Incentive Acknowledgement Rece
Other-Survey- Attachment 5 QRE with
Other-Attachment 6 QRE with Added Ce
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Parents-Minor Surveys
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name 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

Income Security Food and Nutrition Assistance

 

2,915 0
   
Individuals or Households
 
   10 %

  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 5,916 0 0 0 0 5,916
Annual IC Time Burden (Hours) 4,577 0 0 0 0 4,577
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
A 1-Round 1 Advanced Letter to Study Participants-English Appendix A 1-Round 1 Advanced Letter to Study Participants-English.doc 05/05/2011
A 2-Round 1 Advanced Letter to Parents of Minors-English Appendix A 2-Round 1 Advanced Letter to Parents of Minors-English.doc 05/05/2011
A 3-Round 2 Advanced Letter to Study Participants-English Appendix A 3-Round 2 Advanced Letter to Study Participants-English.doc 05/05/2011
A 4-Round 2 Advanced Letter to Parents of Minors-English Appendix A 4-Round 2 Advanced Letter to Parents of Minors-English.doc 05/05/2011
A 5-Round 3 Advanced Letter to Study Participants-English Appendix A 5-Round 3 Advanced Letter to Study Participants-English.doc 05/05/2011
A 6-Round 3 Advanced Letter to Parents of Minors-English Appendix A 6-Round 3 Advanced Letter to Parents of Minors-English.doc 05/05/2011
A 7-Round 1 Advanced Letter to Study Participants-Spanish Appendix A 7-Round 1Advanced Letter to Study Participants-Spanish.doc 05/05/2011
A 8-Round 1 Advanced Letter to Parents of Minors-Spanish Appendix A 8-Round 1 Advanced Letter to Parents of Minors-Spanish.doc 05/06/2011
A 9-Round 2 Advanced Letter to Study Participants-Spanish Appendix A 9-Round 2 Advanced Letter to Study Participants-Spanish.doc 05/06/2011
A 10-Round 2 Advanced Letter to Parents of Minors-Spanish Appendix A 10-Round 2 Advanced Letter to Parents of Minors-Spanish.doc 05/06/2011
A 11-Round 3 Advanced Letter to Study Participants-Spanish Appendix A 11-Round 3 Advanced Letter to Study Participants-Spanish.doc 05/06/2011
A 12-Round 3 Advanced Letter to Parent of Minors-Spanish Appendix A 12-Round 3 Advanced Letter to Parent of Minors-Spanish.doc 05/06/2011
B7 - In person script-English Appendix B7 - In person script-English.doc 05/06/2011
B8 - Voicemail script-English Appendix B8 - Voicemail script-English.doc 05/06/2011
B9 - Refusal strategy and script-English Appendix B9 - Refusal strategy and script-English.doc 05/06/2011
Attachment 2 Round 2 Advance Letter for Minors REV 1-19-12 Attachment 2 Round 2 Advance Letter for Minors REV 1-19-12.docx 01/24/2012
Attachment 3 Round 3 Advance Letter Rev 2-2-12 Attachment 3 Round 3 Advance Letter Rev 2-2-12.docx 02/07/2012
Attachment 4 Round 3 Advance Letter for Minors REV 2-2-12 Attachment 4 Round 3 Advance Letter for Minors REV 2-2-12.docx 02/07/2012
Attachment 7 Round 2 Advance Letter Spanish Rev 2-212 Attachment 7 Round 2 Advance Letter Spanish Rev 2-2-12.docx 02/07/2012
Attachment 8 Round 2 Advance Letter for Minors Spanish Rev 2-2.12 Attachment 8 Round 2 Advance Letter for Minors Spanish Rev 2-2-12.docx 02/07/2012
Attachment 9 Round 3 Advance Letter Spanish rev 2-2-12 Attachment 9 Round 3 Advance Letter Spanish rev 2-2-12.docx 02/07/2012
Attachment 10 Round 3 Advance Letter for Minors Spanish rev 2-2-12 Attachment 10 Round 3 Advance Letter for Minors Spanish rev 2-2-12.docx 02/07/2012
Attachment 1 Round 2 Advance Letter Rev2 2-2-12 Attachment 1 Round 2 Advance Letter Rev2 2-2-12.docx 02/07/2012
Attachment 2 Round 2 Advance Letter for Minors REV 2-2-12 Attachment 2 Round 2 Advance Letter for Minors REV 2-2-12.docx 02/07/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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