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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

IC Title:

CNPP Segmentation Study

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.