Information Collection

Business (For- and Not-for-Profit)

IC 197619 under ICR 201201-0584-006 · OMB 0584-0561.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix E1.doc	Other-Round 1 Participating Independ
Appendix E2.doc	Other-Round 2 Participating Independ
Appendix E3.doc	Other-Round 1 Participating Chain St
Appendix E4.doc	Other-Round 2 Participating Chain St
Appendix E5.doc	Other-Non-Participating Store Survey
Appendix E6.doc	Other-Withdrawn Store Survey
Appendix E7.doc	Other-Newly Participating Store Surv
Appendix E8.doc	Other-Store Observation Form
Appendix F13.docm	Other-Round 1 EBT Contractor (ACS) I
Appendix F14.docm	Other-Round 2 EBT Contractor (ACS) I
Appendix F15.docm	Other-Round 3 EBT Contractor (ACS) I
Appendix F16.docm	Other-Round 1 Integrated Retailers�
Appendix F17.docm	Other-Round 2 Integrated Retailers�
Appendix F18.docm	Other-Round 3 Integrated Retailers�
Appendix F19.docm	Other-Round 1 Third Party Processors
Appendix F20.docm	Other-Round 2 Third Party Processors
Appendix F21.docm	Other-Round 3Third Party Processors
Appendix F22.docm	Other-Round 1 Community Based Organi
Appendix F23.docm	Other-Round 2 Community Based Organi
Appendix F24.docm	Other-Round 3 Community Based Organi
Appendix E9.doc Follow-up Reminder Telephone Script	IC Document
Appendix E10.doc Retailer Telephone Notification Recruiting Script	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Business (For- and Not-for-Profit)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available 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 Retailersï¿½ Interview Guide	Appendix F16.docm	No	Paper Only
Other-Round 2 Integrated Retailersï¿½ Interview Guide	Appendix F17.docm	No	Paper Only
Other-Round 3 Integrated Retailersï¿½ 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

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: 187

Number of Respondents for Small Entity: 125

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	187	187
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.