Information Collection

State Director Survey 2013

IC 196904 under ICR 201312-0584-003 · OMB 0584-0562.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix E State Director Survey Year 3.docx	Other-State Director Survey Year 3
Appendix D2 CN Invitation Letter Year 3.docx Appendix D2 CN Invitation Letter Year 3	IC Document
Appendix D4 Telephone Interviewer Script Year 3.docx Appendix D4 Telephone Interviewer Script Year 3	IC Document
Appendix D5 CN Thank you Letter Year 3.docx Appendix D5 CN Thank you Letter Year 3	IC Document
Appendix D6 Notification to CN Directors of Start of SFA Survey Year 3.docx Appendix D6 Notification to CN Directors of Start of SFA Survey Year 3	IC Document
Appendix D3-1 State CN Follow-up Email Year 3.docx Appendix D3-1 State CN Follow-up Email Year 3	IC Document
Appendix D3-2 State CN Reminder Email Year 3.docx Appendix D3-2 State CN Reminder Email Year 3	IC Document

IC Title:

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-State Director Survey Year 3					Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

Number of Respondents for Small Entity: 1

Affected Public: State, Local, and Tribal Governments

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	243	90	153
Annual IC Time Burden (Hours)	119	7	112
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix D2 CN Invitation Letter Year 3		02/07/2014
Appendix D4 Telephone Interviewer Script Year 3		02/07/2014
Appendix D5 CN Thank you Letter Year 3		02/07/2014
Appendix D6 Notification to CN Directors of Start of SFA Survey Year 3		02/07/2014
Appendix D3-1 State CN Follow-up Email Year 3		02/07/2014
Appendix D3-2 State CN Reminder Email Year 3		02/07/2014

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

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