Information Collection

SNAP Teen Nutrition Pilot Testing (Parents/Students)

IC 222411 under ICR 201503-0584-004 · OMB 0584-0606.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0606 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A - Quantitative Evaluation Survey for High School Students 0...-1.docx	Other-Attachment A - Quantitative Ev
Attachment B - Moderator PRE - Discussion Guide for Focus Groups with Hi....docx	Other-Attachment B - Moderator PRE -
Attachment C - Moderator POST - Discussion Guide for Focus Groups with High School Students060116.docx	Other-Attachment C - Moderator POST
Attachment F - Parent Guardian Focus Group Consent Form for Student Participation 060116.docx	Other-Attachment F - Parent Guardian
0584-0606 FNS SNAP Teen Nutrition Pilot Test OMB Package Memo 7-12-16 clean version-1.docx OMB Justification Memo	IC Document
Attachment G - Teen Nutrition and Physical Activity Program 060216.pdf Attachment G - Teen Nutrition and Physical Activity Program 060216	IC Document

IC Title:

SNAP Teen Nutrition Pilot Testing (Parents/Students)

Agency IC Tracking Number:

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-Attachment A - Quantitative Evaluation Survey for High School Students 0...-1	Attachment A - Quantitative Evaluation Survey for High School Students 0...-1.docx	No	Paper Only
Other-Attachment B - Moderator PRE - Discussion Guide for Focus Groups with High School Students	Attachment B - Moderator PRE - Discussion Guide for Focus Groups with Hi....docx	No	Paper Only
Other-Attachment C - Moderator POST - Discussion Guide for Focus Groups with High School Students060116	Attachment C - Moderator POST - Discussion Guide for Focus Groups with High School Students060116.docx	No	Printable Only
Other-Attachment F - Parent Guardian Focus Group Consent Form for Student Participation 060116	Attachment F - Parent Guardian Focus Group Consent Form for Student Participation 060116.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: 295

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	635	635
Annual IC Time Burden (Hours)	313	313
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Justification Memo	0584-0606 FNS SNAP Teen Nutrition Pilot Test OMB Package Memo 7-12-16 clean version-1.docx	07/12/2016
Attachment G - Teen Nutrition and Physical Activity Program 060216	Attachment G - Teen Nutrition and Physical Activity Program 060216.pdf	07/12/2016

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