Information Collection

Business Respondents

IC 218672 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⚠️ Notice: This information collection may be referencing outdated material.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 Gui
M.3_Participant Information Survey - Employer.docx	Other- M.3_Participant Information S
V.1_Time Use Survey.docx	Other-V.1_Time Use Survey
V.2_Time-Use Survey_ScreenShots.docx	Other-V.2_Time-Use Survey_ScreenShot
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:

Business 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-H_Master Site Visit Protocol		No		Paper Only
Other-I.2_Interview Guide for Providers		No		Paper Only
Other- J.3_Focus Group Moderator Guide for Employers		No		Paper Only
Other- M.3_Participant Information Survey - Employer		No		Paper Only
Other-V.1_Time Use Survey		No		Paper Only
Other-V.2_Time-Use Survey_ScreenShots	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable

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: 690

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	8,560	8,560
Annual IC Time Burden (Hours)	9,908	9,908
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
U_Master Pilot Costs Workbook		10/22/2015
I.3_Observation Guide		10/23/2015
L.3_Focus Group Recruitment Email - Employer		11/09/2015
L.4_Focus Group Confirmation Letter - Employer		11/09/2015
W.1_Time Use Survey Initial Email		11/09/2015
W.2_Time Use Survey Reminder Email		10/26/2015

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

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