Information Collection

Individual/Households Respondents

IC 218669 under ICR 201510-0584-004 · OMB 0584-0604.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0604 can be found here:

2019-02-25 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
C 1_Registration Document_English102915.docx	Other-C.1_Registration Document_Engl
C 2_Registration Document_Spanish102915.docx	Other-C.2_Registration Document_Span
C.3_Registration Document Screenshots.docx www.notyetcreated.com	Other-C.3_Registration Document Scre
D.1_Study Consent Document_English.docx	Other-D.1_Study Consent Document_Eng
D.2_Study Consent Document_Spanish.docx	Other-D.2_Study Consent Document_Spa
D.3_Study Consent Document_Mandatory_English.docx	Other-D.3_Study Consent Document_Man
D.4_Study Consent Document_Mandatory_Spanish.docx	Other-D.4_Study Consent Document_Man
I.1_Interview Guide for Clients.docx	Other-i.1 Interview Guide for Client
J.1_Focus Group Moderator Guide for Clients-English.docx	Other-J.1_Focus Group Moderator Guid
J.2_Focus Group Moderator Guide for Clients-Spanish.docx	Other-J.2_Focus Group Moderator Guid
K.1_Focus Group Recruitment Guide - English.docx	Other-K.1_Focus Group Recruitment Gu
K.2_Focus Group Recruitment Guide - Spanish.docx	Other-K.2_Focus Group Recruitment Gu
M.1_Participant Information Survey - English.docx	Other-M.1_Participant Information Su
M.2_Participant Information Survey - Spanish.docx	Other-M.2_Participant Information Su
O.1_SNAP E&T Pilots 12-Month FollowUp Survey_English.pdf	Other-O.1_SNAP E&T Pilots 12-Month F
O.2_SNAP E&T Pilots 12-Month FollowUp Survey_Spanish.pdf	Other-O.2_SNAP E&T Pilots 12-Month F
O.3_Screenshot 12-month FU Survey.docx	Other-O.3_Screenshot 12-month FU Sur
O.4_SNAP E&T Pilots 36-Month FollowUp Survey_English.pdf	Other-O.4_SNAP E&T Pilots 36-Month F
O.5_SNAP E&T Pilots 36-Month FollowUp Survey_Spanish.pdf	Other-O.5_SNAP E&T Pilots 36-Month F
O.6_Screenshot 36-month FU Survey.docx	Other-O.6_Screenshot 36-month FU Sur
E.1_WelcomePacketLetter_English.docx E.1_WelcomePacketLetter_English	IC Document
E.2_WelcomePacketLetter_Spanish.docx E.2_WelcomePacketLetter_Spanish	IC Document
F.1_Study Brochure.docx F.1_Study Brochure	IC Document
F.2_Study Brochure_Spanish.docx F.2_Study Brochure_Spanish	IC Document
G 1_Seasonal Postcard_English.docx G 1_Seasonal Postcard_English	IC Document
G.2_Seasonal Postcard_Spanish.docx G.2_Seasonal Postcard_Spanish	IC Document
L.1_Focus Group Confirmation Letter - English_gr.docx L.1_Focus Group Confirmation Letter - English_gr	IC Document
L.2_Focus Group Confirmation Letter - Spanish.docx L.2_Focus Group Confirmation Letter - Spanish	IC Document
P.1_Survey Advance Letter_English.docx P.1_Survey Advance Letter_English	IC Document
P.2_Survey Advance Letter_Spanish.docx P.2_Survey Advance Letter_Spanish	IC Document
Q.1_Survey Reminder Letter_English.docx Q.1_Survey Reminder Letter_English	IC Document
Q.2_Survey Reminder Letter_Spanish.docx Q.2_Survey Reminder Letter_Spanish	IC Document
R.1_Survey Reminder Postcard_English.docx R.1_Survey Reminder Postcard_English	IC Document
R.2_Survey Reminder Postcard_Spanish.docx R.2_Survey Reminder Postcard_Spanish	IC Document
S.1_RefusalLetter_English.docx S.1_RefusalLetter_English	IC Document
S.2_RefusalLetter_Spanish.docx S.2_RefusalLetter_Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Individual/Households Respondents

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	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-C.1_Registration Document_English	C 1_Registration Document_English102915.docx		No		Paper Only
Other-C.2_Registration Document_Spanish	C 2_Registration Document_Spanish102915.docx		No		Paper Only
Other-i.1 Interview Guide for Clients	I.1_Interview Guide for Clients.docx		No		Paper Only
Other-C.3_Registration Document Screenshots	C.3_Registration Document Screenshots.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-D.1_Study Consent Document_English	D.1_Study Consent Document_English.docx		No		Paper Only
Other-D.2_Study Consent Document_Spanish	D.2_Study Consent Document_Spanish.docx		No		Paper Only
Other-D.3_Study Consent Document_Mandatory_English	D.3_Study Consent Document_Mandatory_English.docx		No		Paper Only
Other-D.4_Study Consent Document_Mandatory_Spanish	D.4_Study Consent Document_Mandatory_Spanish.docx		No		Paper Only
Other-J.1_Focus Group Moderator Guide for Clients-English	J.1_Focus Group Moderator Guide for Clients-English.docx		No		Paper Only
Other-O.3_Screenshot 12-month FU Survey	O.3_Screenshot 12-month FU Survey.docx		No		Paper Only
Other-O.4_SNAP E&T Pilots 36-Month FollowUp Survey_English	O.4_SNAP E&T Pilots 36-Month FollowUp Survey_English.pdf		No		Paper Only
Other-O.5_SNAP E&T Pilots 36-Month FollowUp Survey_Spanish	O.5_SNAP E&T Pilots 36-Month FollowUp Survey_Spanish.pdf		No		Paper Only
Other-J.2_Focus Group Moderator Guide for Clients-Spanish	J.2_Focus Group Moderator Guide for Clients-Spanish.docx		No		Paper Only
Other-K.1_Focus Group Recruitment Guide - English	K.1_Focus Group Recruitment Guide - English.docx		No		Paper Only
Other-K.2_Focus Group Recruitment Guide - Spanish	K.2_Focus Group Recruitment Guide - Spanish.docx		No		Paper Only
Other-M.1_Participant Information Survey - English	M.1_Participant Information Survey - English.docx		No		Paper Only
Other-M.2_Participant Information Survey - Spanish	M.2_Participant Information Survey - Spanish.docx		No		Paper Only
Other-O.1_SNAP E&T Pilots 12-Month FollowUp Survey_English	O.1_SNAP E&T Pilots 12-Month FollowUp Survey_English.pdf		No		Paper Only
Other-O.2_SNAP E&T Pilots 12-Month FollowUp Survey_Spanish	O.2_SNAP E&T Pilots 12-Month FollowUp Survey_Spanish.pdf		No		Paper Only
Other-O.6_Screenshot 36-month FU Survey	O.6_Screenshot 36-month FU Survey.docx		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: FNS-8 USDA FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 53,851

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	137,303	137,303
Annual IC Time Burden (Hours)	29,478	29,478
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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