Information Collection

SEBTC - Households

IC 196141 under ICR 201212-0584-003 · OMB 0584-0559.

⚠️ Notice: This information collection may be referencing outdated material.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

2014-03-28 - Revision of a currently approved collection

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-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
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

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: 28,667

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	57,334	36,000	21,334
Annual IC Time Burden (Hours)	33,167	18,000	15,167
Annual IC Cost Burden (Dollars)	0	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.