Information Collection

State Agencies

IC 223534 under ICR 201606-0584-002 · OMB 0584-0622.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix C - Script for Survey Telephone Interview (FINAL).docx	Other-Appendix C - SCRIPT FOR SURVEY
Appendix D - Screenshots of Survey Pre-Test Instrument.pdf www.snapsurveys.com/wh/s.asp?k=145577273350.	Other-Appendix D - Screenshots of Su
Appendix J - Survey Pre-Test Feedback Form.docx www.snapsurveys.com/wh/s.asp?k=145577273350.	Other-Appendix J - Survey Pre-Test F
Appendix B1 - State Agency Survey Instrument.docx snapsurveys.com/wh/s.asp?=145577273350	Other-Appendix B1 - State Agency Sur
Appendix B2 - Local Agency Survey Instrument.docx snapsurveys.com/wh/s.asp?=145577273350	Other-Appendix B2 - Local Agency Sur
Appendix E1 - Letter Template from FNS Regional Office to State SNAP Director.docx Appendix E1 - Letter Template from FNS Regional Office to State SNAP Director	IC Document
Appendix E2 - Letter from Study Coordinator to State SNAP Director following FNS Regional Office Letter.docx Appendix E2 - Letter from Study Coordinator to State SNAP Director following FNS Regional Office Letter	IC Document
Appendix E3 - Letter Template from State SNAP Director to Local SNAP Agency Manager.docx Appendix E3 - Letter Template from State SNAP Director to Local SNAP Agency Manager	IC Document
Appendix E4 - Letter from Study Coordinator to Local SNAP Agency Manager.docx Appendix E4 - Letter from Study Coordinator to Local SNAP Agency Manager	IC Document
Appendix E5 - First Letter from Study Coordinator to Survey Non-Respondents.docx Appendix E5 - First Letter from Study Coordinator to Survey Non-Respondents	IC Document
Appendix E6 - Letter from FNS to State or Local SNAP Agency Regarding Non-Response.docx Appendix E6 - Letter from FNS to State or Local SNAP Agency Regarding Non-Response	IC Document
Appendix E7 - Second Letter from Study Coordinator to Survey Non-Respondents.docx Appendix E7 - Second Letter from Study Coordinator to Survey Non-Respondents	IC Document
Appendix E8 - Thank You Letter to Study Participants.docx Appendix E8 - Thank You Letter to Study Participants	IC Document
Appendix E9 - Study Information Sheet Attachment to Letters.docx Appendix E9 - Study Information Sheet Attachment to Letters	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State Agencies

Agency IC Tracking Number:

Is this a Common Form? No

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-Appendix D - Screenshots of Survey Pre-Test Instrument	Appendix D - Screenshots of Survey Pre-Test Instrument.pdf	https://www.snapsurveys.com/wh/s.asp?k=145577273350.	Yes	Yes	Fillable Fileable Signable
Other-Appendix J - Survey Pre-Test Feedback Form	Appendix J - Survey Pre-Test Feedback Form.docx	https://www.snapsurveys.com/wh/s.asp?k=145577273350.	Yes	Yes	Fillable Fileable Signable
Other-Appendix B1 - State Agency Survey Instrument	Appendix B1 - State Agency Survey Instrument.docx	https://snapsurveys.com/wh/s.asp?=145577273350	Yes	Yes	Fillable Fileable Signable
Other-Appendix C - SCRIPT FOR SURVEY TELEPHONE INTERVIEW (FINAL)	Appendix C - Script for Survey Telephone Interview (FINAL).docx		Yes	No	Paper Only
Other-Appendix B2 - Local Agency Survey Instrument	Appendix B2 - Local Agency Survey Instrument.docx	https://snapsurveys.com/wh/s.asp?=145577273350	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 360

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	360	360
Annual IC Time Burden (Hours)	536	536
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix E1 - Letter Template from FNS Regional Office to State SNAP Director	Appendix E1 - Letter Template from FNS Regional Office to State SNAP Director.docx	10/21/2016
Appendix E2 - Letter from Study Coordinator to State SNAP Director following FNS Regional Office Letter	Appendix E2 - Letter from Study Coordinator to State SNAP Director following FNS Regional Office Letter.docx	10/21/2016
Appendix E3 - Letter Template from State SNAP Director to Local SNAP Agency Manager	Appendix E3 - Letter Template from State SNAP Director to Local SNAP Agency Manager.docx	10/21/2016
Appendix E4 - Letter from Study Coordinator to Local SNAP Agency Manager	Appendix E4 - Letter from Study Coordinator to Local SNAP Agency Manager.docx	10/21/2016
Appendix E5 - First Letter from Study Coordinator to Survey Non-Respondents	Appendix E5 - First Letter from Study Coordinator to Survey Non-Respondents.docx	10/21/2016
Appendix E6 - Letter from FNS to State or Local SNAP Agency Regarding Non-Response	Appendix E6 - Letter from FNS to State or Local SNAP Agency Regarding Non-Response.docx	10/21/2016
Appendix E7 - Second Letter from Study Coordinator to Survey Non-Respondents	Appendix E7 - Second Letter from Study Coordinator to Survey Non-Respondents.docx	10/21/2016
Appendix E8 - Thank You Letter to Study Participants	Appendix E8 - Thank You Letter to Study Participants.docx	10/21/2016
Appendix E9 - Study Information Sheet Attachment to Letters	Appendix E9 - Study Information Sheet Attachment to Letters.docx	10/21/2016

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