Information Collection

FDPIR Tribal Leaders, Managers, Staff (State/Local/ Tribal Government)

IC 206347 under ICR 201304-0584-001 · OMB 0584-0583.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ATTACHMENT B1a - Case Record Review.docx	Other-ATTACHMENT B1a - Case Record R
ATTACHMENT B1c - Case Record Review Pretest Outreach Script.docx	Other-ATTACHMENT B1c - Case Record R
ATTACHMENT B2d - Pretest Debriefing Guide.doc	Other-ATTACHMENT B2d - Pretest Debri
ATTACHMENT B4a - Onsite Official Interview Guide.docx	Other-ATTACHMENT B4a - Onsite Offici
04 24 13 ATTACHMENT B4c - Call Script for Site Visit Planning with FDPIR Director.doc	Other-ATTACHMENT B4c - Call Script f
ATTACHMENT B4d - Onsite Official Interview Outreach Script.doc	Other-ATTACHMENT B4d - Onsite Offici
ATTACHMENT B4e - Onsite Official Interview Pretest Outreach Email.docx	Other-ATTACHMENT B4e - Onsite Offici
ATTACHMENT I1 - FDPIR Letter # 1 - To Tribal Leadership from USDA.docx	Other-ATTACHMENT I1 - FDPIR Letter #
ATTACHMENT I2 - FDPIR Letter # 2 - To FDPIR Director from USDA_OUTREACH-RECRUITMENT.docx	Other-ATTACHMENT I2 - FDPIR Letter #
ATTACHMENT I3 - FDPIR Letter # 3 - To FDPIR Director from USDA.docx	Other-ATTACHMENT I3 - FDPIR Letter #
ATTACHMENT I5 - FDPIR Letter # 5 - To Tribal Leadership from Urban Institute.docx	Other-ATTACHMENT I5 - FDPIR Letter #
ATTACHMENT J - INVITATION TO THE RESERVATION TEMPLATE.docx	Other-ATTACHMENT J - INVITATION TO T
04 16 13 ATTACHMENT B1b - Case Record Review Template.docx ATTACHMENT B1b - Case Record Review Template.pdf	IC Document
ATTACHMENT B4b - Site Visit Checklists.docx ATTACHMENT B4b - Site Visit Checklists.docx	IC Document
ATTACHMENT K - Procedures for Accessing Case Records and Abstracting Data.docx ATTACHMENT K - Procedures for Accessing Case Records and Abstracting Data.docx	IC Document
ATTACHMENT L - Responsibilities of Field Interviewers.docx ATTACHMENT L - Responsibilities of Field Interviewers.docx	IC Document
ATTACHMENT M - Procedures for Conducting Site Visits.docx ATTACHMENT M - Procedures for Conducting Site Visits.docx	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

FDPIR Tribal Leaders, Managers, Staff (State/Local/ Tribal Government)

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-ATTACHMENT B1a - Case Record Review.docx	No		Paper Only
Other-ATTACHMENT B1c - Case Record Review Pretest Outreach Script.docx	No		Paper Only
Other-ATTACHMENT B2d - Pretest Debriefing Guide.doc	Yes	Yes	Fillable Fileable
Other-ATTACHMENT B4a - Onsite Official Interview Guide.docx	Yes	Yes	Fillable Fileable
Other-ATTACHMENT B4c - Call Script for Site Visit Planning with FDPIR Director.doc	Yes	Yes	Fillable Fileable
Other-ATTACHMENT B4d - Onsite Official Interview Outreach Script.doc	Yes	Yes	Fillable Fileable
Other-ATTACHMENT B4e - Onsite Official Interview Pretest Outreach Email.docx	Yes	Yes	Fillable Fileable
Other-ATTACHMENT I1 - FDPIR Letter # 1 - To Tribal Leadership from USDA.docx	Yes	Yes	Fillable Fileable
Other-ATTACHMENT I2 - FDPIR Letter # 2 - To FDPIR Director from USDA_OUTREACH-RECRUITMENT.docx	Yes	Yes	Fillable Fileable
Other-ATTACHMENT I3 - FDPIR Letter # 3 - To FDPIR Director from USDA.docx	Yes	Yes	Fillable Fileable
Other-ATTACHMENT I5 - FDPIR Letter # 5 - To Tribal Leadership from Urban Institute.docx	Yes	Yes	Fillable Fileable
Other-ATTACHMENT J - INVITATION TO THE RESERVATION TEMPLATE.docx	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: (SORN) FNS-8 USDA/FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 202

Number of Respondents for Small Entity: 3

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,528	1,528
Annual IC Time Burden (Hours)	248	248
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ATTACHMENT B1b - Case Record Review Template.pdf		04/24/2013
ATTACHMENT B4b - Site Visit Checklists.docx		04/04/2013
ATTACHMENT K - Procedures for Accessing Case Records and Abstracting Data.docx		04/04/2013
ATTACHMENT L - Responsibilities of Field Interviewers.docx		04/04/2013
ATTACHMENT M - Procedures for Conducting Site Visits.docx		04/04/2013

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

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