Information Collection

Shopping Patterns: SNAP Recipient Survey (I/H)

IC 203112 under ICR 201207-0584-001 · OMB 0584-0564.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
FMCS OMB B1 Survey English_v4.docx	Other-FMCS OMB B1 Survey English
FMCS OMB B2 Survey Spanish_v4.docx	Other-FMCS OMB B2 Survey Spanish
FMCS OMB D1 Telephone Script English_v4.docx	Other-FMCS OMB D1 Telephone Script f
FMCS OMB D2 Telephone Script Spanish_v4.docx	Other-FMCS OMB D2 Telephone Script f
FMCS OMB A1 SNAP Participant Study Introductory Letter English_v4.docx FMCS OMB A1 SNAP Participant Study Introductory Letter English	IC Document
FMCS OMB A2 SNAP Participant Study Introductory Letter Spanish_v4.docx FMCS OMB A2 SNAP Participant Study Introductory Letter Spanish	IC Document
FMCS OMB B3 Telephone Survey Screenshots English_v4.doc FMCS OMB B3 Telephone Survey Screenshots English	IC Document
FMCS OMB B4 Telephone Survey Screenshots Spanish_v4.doc FMCS OMB B4 Telephone Survey Screenshots Spanish	IC Document
FMCS OMB C1 SNAP Participant Reminder Letter English_v4.docx FMCS OMB C1 SNAP Participant Reminder Letter English	IC Document
FMCS OMB C2 SNAP Participant Reminder Letter Spanish_v4.docx FMCS OMB C2 SNAP Participant Reminder Letter Spanish	IC Document
FMCS OMB C3 SNAP Participant Thank you letter English.docx FMCS OMB C3 SNAP Participant Thank you letter English	IC Document
FMCS OMB C4 SNAP Participant Thank you letter Spanish.docx FMCS OMB C4 SNAP Participant Thank you letter Spanish	IC Document
FMCS OMB D3 Refusal Conversion English_v4.docx FMCS OMB D3 Refusal Conversion English	IC Document
FMCS OMB D4 Refusal Conversion Spanish_v4.docx FMCS OMB D4 Refusal Conversion Spanish	IC Document
FMCS OMB D5 Automated Phone Calls English_v4.docx FMCS OMB D5 Automated Phone Calls English	IC Document
FMCS OMB D6 Automated Phone Calls Spanish_v4.docx FMCS OMB D6 Automated Phone Calls Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Shopping Patterns: SNAP Recipient Survey (I/H)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-FMCS OMB B1 Survey English		No		Paper Only
Other-FMCS OMB B2 Survey Spanish		No		Paper Only
Other-FMCS OMB D1 Telephone Script for Survey via Interview English	N/A - Interview responses are filed electronically	Yes	Yes	Fillable Fileable
Other-FMCS OMB D2 Telephone Script for Survey via Interview Spanish	N/A - Interview responses are filed electronically	Yes	Yes	Fillable Fileable

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: 3,724

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,724	3,724
Annual IC Time Burden (Hours)	3,539	3,539
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FMCS OMB A1 SNAP Participant Study Introductory Letter English		07/10/2012
FMCS OMB A2 SNAP Participant Study Introductory Letter Spanish		07/10/2012
FMCS OMB B3 Telephone Survey Screenshots English		07/10/2012
FMCS OMB B4 Telephone Survey Screenshots Spanish		07/10/2012
FMCS OMB C1 SNAP Participant Reminder Letter English		07/11/2012
FMCS OMB C2 SNAP Participant Reminder Letter Spanish		07/11/2012
FMCS OMB C3 SNAP Participant Thank you letter English		07/11/2012
FMCS OMB C4 SNAP Participant Thank you letter Spanish		07/11/2012
FMCS OMB D3 Refusal Conversion English		07/11/2012
FMCS OMB D4 Refusal Conversion Spanish		07/11/2012
FMCS OMB D5 Automated Phone Calls English		07/11/2012
FMCS OMB D6 Automated Phone Calls Spanish		07/11/2012

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

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