Information Collection

State Agency

IC 218671 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
H_Master Site Visit Protocol.docx	Other-H_Master Site Visit Protocol
I.2_Interview Guide for Providers.docx	Other-I.2_Interview Guide for Provid
J.3_Focus Group Moderator Guide for Employers.docx	Other-J.3_Focus Group Moderator Guid
M.3_Participant Information Survey - Employer.docx	Other-M.3_Participant Information Su
V.1_Time Use Survey.docx	Other-V.1_Time Use Survey
V.2_Time-Use Survey_ScreenShots.docx www.notyetcreated.com	Other-V.2_Time-Use Survey_ScreenShot
T_SNAPET_dataitems_FINAL.docx T_SNAPET_admindataitems_FINAL	IC Document
U_Master Pilot Costs Workbook.xlsx U_Master Pilot Costs Workbook	IC Document
I.3_Observation Guide.docx I.3_Observation Guide	IC Document
L.3_Focus Group Recruitment Email - Employer.docx L.3_Focus Group Recruitment Email - Employer	IC Document
L.4_Focus Group Confirmation Letter - Employer.docx L.4_Focus Group Confirmation Letter - Employer	IC Document
W.1_Time Use Survey Initial Email.docx W.1_Time Use Survey Initial Email	IC Document
W.2_Time Use Survey Reminder Email.docx W.2_Time Use Survey Reminder Email	IC Document

IC Title:

State Agency

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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-H_Master Site Visit Protocol	H_Master Site Visit Protocol.docx		No		Paper Only
Other-I.2_Interview Guide for Providers	I.2_Interview Guide for Providers.docx		No		Paper Only
Other-M.3_Participant Information Survey - Employer	M.3_Participant Information Survey - Employer.docx		No		Paper Only
Other-V.1_Time Use Survey	V.1_Time Use Survey.docx		No		Paper Only
Other-V.2_Time-Use Survey_ScreenShots	V.2_Time-Use Survey_ScreenShots.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-J.3_Focus Group Moderator Guide for Employers	J.3_Focus Group Moderator Guide for Employers.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: USDA/FNS-10 Persons Doing Business with the Food and Nutrition Service,

FR Citation: 65 FR 17252

Number of Respondents: 190

Number of Respondents for Small Entity: 0

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
Annual Number of Responses for this IC	1,100	1,100
Annual IC Time Burden (Hours)	1,585	1,585
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
T_SNAPET_admindataitems_FINAL	T_SNAPET_dataitems_FINAL.docx	10/22/2015
U_Master Pilot Costs Workbook	U_Master Pilot Costs Workbook.xlsx	10/22/2015
I.3_Observation Guide	I.3_Observation Guide.docx	10/23/2015
L.3_Focus Group Recruitment Email - Employer	L.3_Focus Group Recruitment Email - Employer.docx	11/09/2015
L.4_Focus Group Confirmation Letter - Employer	L.4_Focus Group Confirmation Letter - Employer.docx	11/09/2015
W.1_Time Use Survey Initial Email	W.1_Time Use Survey Initial Email.docx	11/09/2015
W.2_Time Use Survey Reminder Email	W.2_Time Use Survey Reminder Email.docx	11/09/2015

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