SNAP work registrants and E&T program participants

InsTrument I.3

SNAP Employment and Training (E&T) Focus Group Participant Information Form

OMB # xxxx-xxxx

Expiration: xx/xx/20xx

Reference no.: 40272.401

SNAP Employment and Training (E&T) Participant Focus Group

Participant Information Form

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection will be entered after clearance. The time required to complete this information collection is estimated to average 90 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

FINAL

Instrument I.3 Focus Group Participant Form

SNAP Employment & Training Focus Group Demographics

1. What is your gender?

• Female

• Male

2. How old are you?

_____ years old

3. Are you Hispanic or Latino?

• Yes

• No

4. What is your race? Mark all that apply.

• American Indian or Alaska Native

• Asian

• Black, African American

• Native Hawaiian or other Pacific Islander

• White, Caucasian

• Other _________________________

5. What is the highest level of education you have completed?

• Did not complete high school

• High school/GED

• Some college

• Associate’s degree

• Bachelor’s degree

• Master’s degree or above

6. Are you currently working?

• Yes, full-time (35 hours per week or more)

• Yes, part-time (1 to 35 hours per week)

• No

7. [If not currently working:] How long have you been unemployed?

• Never held a job or looked for work

• 6 months or less

• 7 months to 2 years

• Over 2 years

8. Which of the following have made it difficult for you to find or keep work?
Mark all that apply.

• Limited English

• Difficulty reading/writing

• Health problems or disability

• Alcohol and/or drug use

• Criminal record

• Don’t have transportation

• Caring for others (children, parents, etc.)

• None of the above