Information Collection

SEBTC - Households

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0559 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A English baseline instrument 3 15 Final.doc	Other-Baseline Questionnaire - Engli
Appendix A Spanish baseline instrument 3 15 11 final.doc	Other-Appendix A :Spanish baseline i
Appendix B English Follow-Up instrument 3 16 11 Final.doc	Other-Appendix B: English Follow-Up
Appendix B Follow-Up questionnaire SPANISH (3-16-11) Final.doc	Other-Appendix B Follow-Up questionn
Attachment A - Current approved Spring baseline instrument (2) -Jan 5-2012-sent to FNS Feb 17 2012.docx	Other-Revised Attachment A - Current
Attachment B - Proposed Spring_2012_QX_011712.docx	Other-Revised Attachment B - Propose
Attachment B.1 - Proposed Spring_SPANISH_2012.docx	Other-Attachment B.1 - Proposed Spri
Attachment E.1 -- Proposed Summer_SPANISH_2012_QX.docx	Other-Attachment E.1 -- Proposed Sum
Advance Letter Baseline Combined_REV Final.doc Advance Letter Baseline Combined	IC Document
Appendix K Participant Consent Language 2-8-2011.docx Consent Telephone Script (I/H)	IC Document
Advance Letter Baseline Combined_REV(SPANISH) Final.docx Advance Letter Baseline Combined_REV(SPANISH) Final.docx	IC Document
Advance Letter_FollowUp_Control_Eng_v1 Final.docx Advance Letter_FollowUp_Control_Eng	IC Document
Advance Letter_FollowUp_Control_Spanish_v3 Final.docx Advance Letter_FollowUp_Control_Spanish	IC Document
Advance Letter_FollowUp_Treatment_Eng_v1 Final.docx Advance Letter_FollowUp_Treatment_Eng	IC Document
Advance Letter_FollowUp_Treatment_Spanish_v3 Final.docx Advance Letter_FollowUp_Treatment_Spanish	IC Document
Attachment C REVISED_ENGLISH Proposed_Advance Letter Baseline_010512-sent to FNS Jan 17.docx Revised Attachment C_Proposed_Advance Letter Baseline_010512-sent to FNS Jan 17	IC Document
Attachment C.1 REVISED Proposed _Spanish_Advanced Letter Baseline_022012 to FNS.docx Att C_Proposed_Spanish_Advance Letter Baseline _022012 to FNS	IC Document
Attachment F REVISED_ENGLISH Proposed Advance Letter Summer _3-8-12.docx Att F_Proposed_Advance Letter Summer _English	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

SEBTC - Households

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	Available 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

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: 10,667

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	21,334	21,334
Annual IC Time Burden (Hours)	15,167	15,167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.