OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

SEBTC - Households

IC 196141 under ICR 201201-0584-009 · OMB 0584-0559.

Documents and Forms
Document Name
Document Type
Other-Baseline Questionnaire - Engli
Other-Appendix A :Spanish baseline i
Other-Appendix B: English Follow-Up
Other-Appendix B Follow-Up questionn
Other-Revised Attachment A - Current
Other-Revised Attachment B - Propose
Other-Attachment B.1 - Proposed Spri
Other-Attachment E.1 -- Proposed Sum
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)

SEBTC - Households
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Appendix A :Spanish baseline instrument Appendix A Spanish baseline instrument 3 15 11 final.doc No   Paper Only
Other-Appendix B: English Follow-Up instrument Appendix B English Follow-Up instrument 3 16 11 Final.doc No   Paper Only
Other-Appendix B Follow-Up questionnaire SPANISH Appendix B Follow-Up questionnaire SPANISH (3-16-11) Final.doc No   Paper Only
Other-Revised Attachment A - Current approved Spring baseline instrument (2) -Jan 5-2012-sent to FNS Feb 17 2012 Attachment A - Current approved Spring baseline instrument (2) -Jan 5-2012-sent to FNS Feb 17 2012.docx No   Paper Only
Other-Revised Attachment B - Proposed Spring_2012_QX_011712 Attachment B - Proposed Spring_2012_QX_011712.docx No   Paper Only
Other-Attachment B.1 - Proposed Spring_SPANISH_2012 Attachment B.1 - Proposed Spring_SPANISH_2012.docx No   Paper Only
Other-Attachment E.1 -- Proposed Summer_SPANISH_2012_QX Attachment E.1 -- Proposed Summer_SPANISH_2012_QX.docx No   Paper Only
Other-Baseline Questionnaire - English & Spanish Appendix A English baseline instrument 3 15 Final.doc No   Paper Only

Income Security Food and Nutrition Assistance

 

10,667 0
   
Individuals or Households
 
   0 %

  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 21,334 0 0 0 0 21,334
Annual IC Time Burden (Hours) 15,167 0 0 0 0 15,167
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Advance Letter Baseline Combined Advance Letter Baseline Combined_REV Final.doc 03/17/2011
Consent Telephone Script (I/H) Appendix K Participant Consent Language 2-8-2011.docx 02/08/2011
Advance Letter Baseline Combined_REV(SPANISH) Final.docx Advance Letter Baseline Combined_REV(SPANISH) Final.docx 03/17/2011
Advance Letter_FollowUp_Control_Eng Advance Letter_FollowUp_Control_Eng_v1 Final.docx 03/17/2011
Advance Letter_FollowUp_Control_Spanish Advance Letter_FollowUp_Control_Spanish_v3 Final.docx 03/17/2011
Advance Letter_FollowUp_Treatment_Eng Advance Letter_FollowUp_Treatment_Eng_v1 Final.docx 03/17/2011
Advance Letter_FollowUp_Treatment_Spanish Advance Letter_FollowUp_Treatment_Spanish_v3 Final.docx 03/17/2011
Revised Attachment C_Proposed_Advance Letter Baseline_010512-sent to FNS Jan 17 Attachment C REVISED_ENGLISH Proposed_Advance Letter Baseline_010512-sent to FNS Jan 17.docx 03/08/2012
Att C_Proposed_Spanish_Advance Letter Baseline _022012 to FNS Attachment C.1 REVISED Proposed _Spanish_Advanced Letter Baseline_022012 to FNS.docx 03/08/2012
Att F_Proposed_Advance Letter Summer _English Attachment F REVISED_ENGLISH Proposed Advance Letter Summer _3-8-12.docx 03/08/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.