Information Collection

SNAP-Eligible Qualitative Research (Individuals/Households 18-75 years) Respondents + non-respondents

IC 232510 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⚠️ Notice: This information collection may be referencing outdated material.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 C-1 Screener (English)_062718.docx	Other-Attachment C-1 Screener (Engli
Attachment C-2 Screener (Spanish)_062718.docx	Other-Attachment C-2 Screener (Spani
Attachment E-1 Focus Group Confirmation Form (English)_062718.docx	Other-Attachment E-1 Focus Group Con
Attachment E-2 Focus Group Confirmation Form (Spanish)_062718.docx	Other-Attachment E-2 Focus Group Con
Attachment F-1 Focus Group Guide (English)_062718.docx	Other-Attachment F-1 Focus Group Gui
Attachment F-2 Focus Group Guide (Spanish)_062718.docx	Other-Attachment F-2 Focus Group Gui
Attachment G-1 Focus Group Stimuli Email Newsletter (English) (1).pdf	Other-Attachment G-1 Focus Group Sti
Attachment G-2 Focus Group Stimuli Email Newsletter (Spanish) (1).pdf	Other-Attachment G-2 Focus Group Sti
Attachment H-1 Focus Group Stimuli Social Media (English) (1).pdf	Other-Attachment H-1 Focus Group Sti
Attachment H-2 Focus Group Stimuli Social Media (Spanish) (1).pdf	Other-Attachment H-2 Focus Group Sti
Attachment I-1 Focus Group Stimuli Apple and Peanut Butter Wrap Video (English).docx VIDEO TRANSCRIBED	Other-Attachment I-1 Focus Group Sti
Attachment I-2 Focus Group Stimuli Apple and Peanut Butter Wrap Video (Spanish).docx VIDEO TRANSCRIBED	Other-Attachment I-2 Focus Group Sti
Attachment J-1 Focus Group Stimuli Frozen Fruit Cups Video (English).docx VIDEO TRANSCRIBED	Other-Attachment J-1 Focus Group Sti
Attachment J-2 Focus Group Stimuli Frozen Fruit Cups Video 8-1-18 (Spanish).docx VIDEO TRANSCRIBED	Other-Attachment J-2 Focus Group Sti
Attachment K-1 Focus Group Handout #1 (English)_062718.docx	Other-Attachment K-1 Focus Group Han
Attachment K-2 Focus Group Handout #1 (Spanish)_062718.docx	Other-Attachment K-2 Focus Group Han
Attachment L-1 Focus Group Handout #2 (English)_062718.docx	Other-Attachment L-1 Focus Group Han
Attachment L-2 Focus Group Handout #2 (Spanish).docx	Other-Attachment L-2 Focus Group Han
0584-0523 Generic Clearance Memo 8.21.18.docx Generic OMB Memo Aug 21 2018	IC Document
Attachment A-1 Privacy Act Statement (English)_062718.docx Attachment A-1 Privacy Act Statement (English)_062718.docx	IC Document
Attachment A-2 Privacy Act Statement (Spanish)_062718.docx Attachment A-2 Privacy Act Statement (Spanish)_062718.docx	IC Document
Attachment B-1 Confidentiality Agreement_062718.docx Attachment B-1 Confidentiality Agreement_062718.docx	IC Document
Attachment D-1 Consent Form (English)_062718.docx Attachment D-1 Consent Form (English)	IC Document
Attachment D-2 Consent Form (Spanish)_062718.docx Attachment D-2 Consent Form (Spanish)_062718.docx	IC Document
Copy of Attachment M-1 Burden Hours Table_062718 (002).xlsx Attachment M-1 Burden Hours Table_062718.xlsx	IC Document
Attachment N Social Marketing and PSE Descriptions from SNAP Plan Guidance FY 2018.docx Attachment N Social Marketing and PSE Descriptions from SNAP Plan Guidance FY 8-1 2018.docx	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

SNAP-Eligible Qualitative Research (Individuals/Households 18-75 years) Respondents + non-respondents

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?	Electronic Capability
Other-Attachment C-1 Screener (English)_062718.docx	Attachment C-1 Screener (English)_062718.docx		No	Paper Only
Other-Attachment C-2 Screener (Spanish)_062718.docx	Attachment C-2 Screener (Spanish)_062718.docx		No	Paper Only
Other-Attachment E-1 Focus Group Confirmation Form (English)_062718.docx	Attachment E-1 Focus Group Confirmation Form (English)_062718.docx		No	Paper Only
Other-Attachment E-2 Focus Group Confirmation Form (Spanish)_062718.docx	Attachment E-2 Focus Group Confirmation Form (Spanish)_062718.docx		No	Paper Only
Other-Attachment F-1 Focus Group Guide (English)_062718.docx	Attachment F-1 Focus Group Guide (English)_062718.docx		No	Paper Only
Other-Attachment F-2 Focus Group Guide (Spanish)_062718.docx	Attachment F-2 Focus Group Guide (Spanish)_062718.docx		No	Paper Only
Other-Attachment G-1 Focus Group Stimuli Email Newsletter (English)(1).pdf	Attachment G-1 Focus Group Stimuli Email Newsletter (English) (1).pdf		No	Paper Only
Other-Attachment G-2 Focus Group Stimuli Email Newsletter (Spanish)(1).pdf	Attachment G-2 Focus Group Stimuli Email Newsletter (Spanish) (1).pdf		No	Paper Only
Other-Attachment H-1 Focus Group Stimuli Social Media (English)(1).pdf	Attachment H-1 Focus Group Stimuli Social Media (English) (1).pdf		No	Paper Only
Other-Attachment H-2 Focus Group Stimuli Social Media (Spanish) (1).pdf	Attachment H-2 Focus Group Stimuli Social Media (Spanish) (1).pdf		No	Paper Only
Other-Attachment I-1 Focus Group Stimuli Apple and Peanut Butter Wrap Video (English).docx	Attachment I-1 Focus Group Stimuli Apple and Peanut Butter Wrap Video (English).docx	VIDEO TRANSCRIBED	No	Paper Only
Other-Attachment I-2 Focus Group Stimuli Apple and Peanut Butter Wrap Video (Spanish).docx	Attachment I-2 Focus Group Stimuli Apple and Peanut Butter Wrap Video (Spanish).docx	VIDEO TRANSCRIBED	No	Paper Only
Other-Attachment J-1 Focus Group Stimuli Frozen Fruit Cups Video (English).docx	Attachment J-1 Focus Group Stimuli Frozen Fruit Cups Video (English).docx	VIDEO TRANSCRIBED	No	Paper Only
Other-Attachment J-2 Focus Group Stimuli Frozen Fruit Cups Video 8-1-18 (Spanish).docx	Attachment J-2 Focus Group Stimuli Frozen Fruit Cups Video 8-1-18 (Spanish).docx	VIDEO TRANSCRIBED	No	Paper Only
Other-Attachment K-1 Focus Group Handout #1 (English)_062718.docx	Attachment K-1 Focus Group Handout #1 (English)_062718.docx		No	Paper Only
Other-Attachment K-2 Focus Group Handout #1 (Spanish)_062718.docx	Attachment K-2 Focus Group Handout #1 (Spanish)_062718.docx		No	Paper Only
Other-Attachment L-1 Focus Group Handout #2 (English)_062718.docx	Attachment L-1 Focus Group Handout #2 (English)_062718.docx		No	Paper Only
Other-Attachment L-2 Focus Group Handout #2 (Spanish).docx	Attachment L-2 Focus Group Handout #2 (Spanish).docx		No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-8 USDA/FNS Studies and Reports

FR Citation: 65 FR 17251

Number of Respondents: 840

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	840	840
Annual IC Time Burden (Hours)	497	497
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic OMB Memo Aug 21 2018	0584-0523 Generic Clearance Memo 8.21.18.docx	08/27/2018
Attachment A-1 Privacy Act Statement (English)_062718.docx	Attachment A-1 Privacy Act Statement (English)_062718.docx	08/01/2018
Attachment A-2 Privacy Act Statement (Spanish)_062718.docx	Attachment A-2 Privacy Act Statement (Spanish)_062718.docx	08/01/2018
Attachment B-1 Confidentiality Agreement_062718.docx	Attachment B-1 Confidentiality Agreement_062718.docx	08/01/2018
Attachment D-1 Consent Form (English)	Attachment D-1 Consent Form (English)_062718.docx	08/01/2018
Attachment D-2 Consent Form (Spanish)_062718.docx	Attachment D-2 Consent Form (Spanish)_062718.docx	08/01/2018
Attachment M-1 Burden Hours Table_062718.xlsx	Copy of Attachment M-1 Burden Hours Table_062718 (002).xlsx	08/27/2018
Attachment N Social Marketing and PSE Descriptions from SNAP Plan Guidance FY 8-1 2018.docx	Attachment N Social Marketing and PSE Descriptions from SNAP Plan Guidance FY 2018.docx	08/27/2018

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