Information Collection

BUSINESS: SNAP E&T Program Providers (Respondents + Pretest)

IC 214461 under ICR 201512-0584-009 · OMB 0584-0602.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
INSTRUMENT 2_Provider Survey _clean.docx www.notyetcreated.com	Other-INSTRUMENT 2_Provider Survey _
INSTRUMENT 2.1_Provider Survey web based 1.12.2015.pdf www.notyetcreated.com	Other-INSTRUMENT 2.1_Provider Survey
ATTACHMENT 8_Provider Survey Advance Letter - email_Response 11-26-14.docx ATTACHMENT 8_Provider Survey Advance Letter - email_Response 11-26-14	IC Document
ATTACHMENT 9_Provider Survey Reminder Email_Response 11-26-14.docx ATTACHMENT 9_Provider Survey Reminder Email_Response 11-26-14	IC Document
ATTACHMENT 10_Provider Survey Reminder Postcard 02.25.15.docx ATTACHMENT 10_Provider Survey Reminder Postcard_clean	IC Document
Attachment A Letter for Change Justification 0584 - SNAP Employment and Training Study 1-5-16.docx Letter to Increase Response Rate and Participation	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-INSTRUMENT 2_Provider Survey _clean			INSTRUMENT 2_Provider Survey _clean.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-INSTRUMENT 2.1_Provider Survey web based 1.12.2015			INSTRUMENT 2.1_Provider Survey web based 1.12.2015.pdf	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 250

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	917	413	504
Annual IC Time Burden (Hours)	307	14	293
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ATTACHMENT 8_Provider Survey Advance Letter - email_Response 11-26-14	ATTACHMENT 8_Provider Survey Advance Letter - email_Response 11-26-14.docx	12/30/2014
ATTACHMENT 9_Provider Survey Reminder Email_Response 11-26-14	ATTACHMENT 9_Provider Survey Reminder Email_Response 11-26-14.docx	12/30/2014
ATTACHMENT 10_Provider Survey Reminder Postcard_clean	ATTACHMENT 10_Provider Survey Reminder Postcard 02.25.15.docx	02/25/2015
Letter to Increase Response Rate and Participation	Attachment A Letter for Change Justification 0584 - SNAP Employment and Training Study 1-5-16.docx	01/05/2016

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