Information Collection

Shopping Patterns: SNAP Recipient Focus Group (I/H)

IC 203119 under ICR 201207-0584-001 · OMB 0584-0564.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
FMCS OMB E5 Focus Group Moderator Guide for Frequent Shoppers English_v4.docx	Other-FMCS OMB E5 Focus Group Modera
FMCS OMB E6. Focus Group Moderator Guide for Non Shoppers English_v4.docx	Other-FMCS OMB E6. Focus Group Moder
FMCS OMB E7 Focus Group Moderator Guide for Frequent Shoppers Spanish_v4.docx	Other-FMCS OMB E7 Focus Group Modera
FMCS OMB E8 Focus Group Moderator Guide for Non Shopper Spanish_V4.docx	Other-FMCS OMB E7 Focus Group Modera
FMCS OMB E1 Focus group recruitment script English_v4.docx FMCS OMB E1 Focus group recruitment script English	IC Document
FMCS OMB E2 Focus group recruitment script Spanish_v4_ALL SPANISH-Span.docx FMCS OMB E2 Focus group recruitment script Spanish	IC Document
FMCS OMB E3 Focus Group Consent form English_v4.docx FMCS OMB E3 Focus Group Consent form English	IC Document
FMCS OMB E4 Focus Group Consent form Spanish_v4.docx FMCS OMB E4 Focus Group Consent form Spanish	IC Document
FMCS OMB E9 Focus Group Incentive Receipt form English v4.docx FMCS OMB E9 Focus Group Incentive Receipt form English	IC Document
FMCS OMB E10 Focus Group Incentive Receipt form Spanish_v4.docx FMCS OMB E10 Focus Group Incentive Receipt form Spanish	IC Document
FMCS OMB E11 Focus Group Recruitment Flyer English.docx FMCS OMB E11 Focus Group Recruitment Flyer English	IC Document
FMCS OMB E12 Focus Group Recruitment Flyer Spanish.docx FMCS OMB E12 Focus Group Recruitment Flyer Spanish	IC Document

IC Title:

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	Instrument File	Available Electronically?	Electronic Capability
Other-FMCS OMB E5 Focus Group Moderator Guide for Frequent Shoppers English	FMCS OMB E5 Focus Group Moderator Guide for Frequent Shoppers English_v4.docx	No	Paper Only
Other-FMCS OMB E6. Focus Group Moderator Guide for Non Shoppers English	FMCS OMB E6. Focus Group Moderator Guide for Non Shoppers English_v4.docx	No	Paper Only
Other-FMCS OMB E7 Focus Group Moderator Guide for Frequent Shoppers Spanish	FMCS OMB E7 Focus Group Moderator Guide for Frequent Shoppers Spanish_v4.docx	No	Paper Only
Other-FMCS OMB E7 Focus Group Moderator Guide for Frequent Shoppers Spanish	FMCS OMB E8 Focus Group Moderator Guide for Non Shopper Spanish_V4.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	160	160
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FMCS OMB E1 Focus group recruitment script English	FMCS OMB E1 Focus group recruitment script English_v4.docx	07/11/2012
FMCS OMB E2 Focus group recruitment script Spanish	FMCS OMB E2 Focus group recruitment script Spanish_v4_ALL SPANISH-Span.docx	08/23/2012
FMCS OMB E3 Focus Group Consent form English	FMCS OMB E3 Focus Group Consent form English_v4.docx	07/11/2012
FMCS OMB E4 Focus Group Consent form Spanish	FMCS OMB E4 Focus Group Consent form Spanish_v4.docx	07/11/2012
FMCS OMB E9 Focus Group Incentive Receipt form English	FMCS OMB E9 Focus Group Incentive Receipt form English v4.docx	07/11/2012
FMCS OMB E10 Focus Group Incentive Receipt form Spanish	FMCS OMB E10 Focus Group Incentive Receipt form Spanish_v4.docx	07/11/2012
FMCS OMB E11 Focus Group Recruitment Flyer English	FMCS OMB E11 Focus Group Recruitment Flyer English.docx	07/11/2012
FMCS OMB E12 Focus Group Recruitment Flyer Spanish	FMCS OMB E12 Focus Group Recruitment Flyer Spanish.docx	07/11/2012

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