Information Collection

CNPP Segmentation Study

IC 224081 under ICR 201601-0584-002 · OMB 0584-0523.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0523 can be found here:

Documents and Forms

Document Name Document Type
Attachment B-1 Survey Screener (English)_ 10-10-16.docx www.knowledgepanel.com Other-Attachment B-1 Survey Screener
Attachment B-2 Survey Screener (Spanish)_ 10 10 16.docx www.knowledgepanel.com Other-Attachment B-2 Survey Screener
Attachment C-1 Survey Instrument (English)_10 20 16.docx www.knowledgepanel.com Other-Attachment C-1 Survey Instrume
Attachment C-2 Survey Instrument (Spanish)_10 10 16.docx www.knowledgepanel.com Other-Attachment C-2 Survey Instrume
Attachment D-1 Consent Form (English)_ 10 20 16.docx www.knowledgepanel.com Other-Attachment D-1 Consent Form (E
Attachment D-2 Consent Form (Spanish)_ 10 20 16.DOCX www.knowledgepanel.com Other-Attachment D-2 Consent Form (S
CNPP OMB Cover Memo 0584-0523_Task 1_quant_to be submitted 11 1 16 clean.docx OMB Justification Memo IC Document
Attachment A-1 Survey Invitation (English) 10-10-16.docx Attachment A-1 Survey Invitation English 10-10-16 IC Document
Attachment A-2 Survey Invitation (Spanish) 10 10 16.docx Attachment A-2 Survey Invitation Spanish 10 10 16 IC Document
Attachment E-1 Trained Contractor Privacy Agreement 10 10 16.docx Attachment E-1 Trained Contractor Privacy Agreement 10 10 16 IC Document
Attachment F-1 Privacy Act Statement (English) 10 10 16.docx Attachment F-1 Privacy Act Statement (English) 10 10 16 IC Document
Attachment F-2 Privacy Act Statement (Spanish) 10 10 16.docx Attachment F-2 Privacy Act Statement (Spanish) 10 10 16 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CNPP Segmentation Study	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment B-1 Survey Screener (English)_ 10-10-16	Attachment B-1 Survey Screener (English)_ 10-10-16.docx	http://www.knowledgepanel.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment B-2 Survey Screener (Spanish)_ 10 10 16	Attachment B-2 Survey Screener (Spanish)_ 10 10 16.docx	http://www.knowledgepanel.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment C-1 Survey Instrument (English)_10 20 16	Attachment C-1 Survey Instrument (English)_10 20 16.docx	http://www.knowledgepanel.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment C-2 Survey Instrument (Spanish)_10 10 16	Attachment C-2 Survey Instrument (Spanish)_10 10 16.docx	http://www.knowledgepanel.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment D-1 Consent Form (English)_ 10 20 16	Attachment D-1 Consent Form (English)_ 10 20 16.docx	http://www.knowledgepanel.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment D-2 Consent Form (Spanish)_ 10 20 16	Attachment D-2 Consent Form (Spanish)_ 10 20 16.DOCX	http://www.knowledgepanel.com	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: USDA FNS 8 Studies and Reports	FR Citation: 65 FR 17252

Number of Respondents: 3,625	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,537	13,537
Annual IC Time Burden (Hours)	1,076	1,076
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Justification Memo	CNPP OMB Cover Memo 0584-0523_Task 1_quant_to be submitted 11 1 16 clean.docx	11/01/2016
Attachment A-1 Survey Invitation English 10-10-16	Attachment A-1 Survey Invitation (English) 10-10-16.docx	11/01/2016
Attachment A-2 Survey Invitation Spanish 10 10 16	Attachment A-2 Survey Invitation (Spanish) 10 10 16.docx	11/01/2016
Attachment E-1 Trained Contractor Privacy Agreement 10 10 16	Attachment E-1 Trained Contractor Privacy Agreement 10 10 16.docx	11/01/2016
Attachment F-1 Privacy Act Statement (English) 10 10 16	Attachment F-1 Privacy Act Statement (English) 10 10 16.docx	11/01/2016
Attachment F-2 Privacy Act Statement (Spanish) 10 10 16	Attachment F-2 Privacy Act Statement (Spanish) 10 10 16.docx	11/01/2016

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