CNPP Segmentation Study

Generic Clearance to Conduct Formative Research/CNPP

OMB: 0584-0523

IC ID: 224081

Documents and Forms
Document Name
Document Type
Other-Attachment B-1 Survey Screener
Other-Attachment B-2 Survey Screener
Other-Attachment C-1 Survey Instrume
Other-Attachment C-2 Survey Instrume
Other-Attachment D-1 Consent Form (E
Other-Attachment D-2 Consent Form (S
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

CNPP Segmentation Study
 
New
 
Voluntary
 

Document Type Form No. Form Name 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

Income Security Food and Nutrition Assistance

USDA FNS 8 Studies and Reports  65 FR 17252

3,625 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 13,537 0 13,537 0 0 0
Annual IC Time Burden (Hours) 1,076 0 1,076 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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