Information Collection

State Director Survey 2013

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Director Survey 2013	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-State Director Survey Year 3			Appendix E State Director Survey Year 3.docx		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 %

	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

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

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