Information Collection

Individuals/Households

IC 222025 under ICR 201606-0584-006 · OMB 0584-0618.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix B20 NAMES Recruitment Call Script.docx	Other-Appendix B20 NAMES Recruitment
Appendix B21 NAMES Recruitment Call Script_Spanish.docx	Other-Appendix B21 NAMES Recruitment
Appendix C19 NAMES Survey Consent Form.docx	Other-Appendix C19 NAMES Survey Cons
Appendix C20 NAMES Survey Consent Form-Spanish.docx	Other-Appendix C20 NAMES Survey Cons
Appendix C23 NAMES Survey Income Worksheet.docx	Other-Appendix C23 NAMES Survey Inco
Appendix C24 NAMES Survey Income Worksheet_Spanish.docx	Other-Appendix C24 NAMES Survey Inco
Appendix C25 NAMES Survey.docx	Other-Appendix C25 NAMES Survey
Appendix C26 NAMES Survey_Spanish.docx	Other-Appendix C26 NAMES Survey - Sp
Appendix C29 NAMES Survey Incentive Received Form.doc	Other-Appendix C29 NAMES Survey Ince
Appendix C30 NAMES Survey Incentive Received Form_Spanish.doc	Other-Appendix C30 NAMES Survey Ince
Appendix B16 NAMES Introductory Letter.docx Appendix B16 NAMES Introductory Letter	IC Document
Appendix B17 NAMES Introductory Letter_Spanish.docx Appendix B17 NAMES Introductory Letter - Spanish	IC Document
Appendix B18 NAMES Brochure.docx Appendix B18 NAMES Brochure	IC Document
Appendix B19 NAMES Brochure-Spanish.docx Appendix B19 NAMES Brochure - Spanish	IC Document
Appendix C21 NAMES Appointment Reminder Letter.docx Appendix C21 NAMES Appointment Reminder Letter	IC Document
Appendix C22 NAMES Appointment Reminder Letter_Spanish.docx Appendix C22 NAMES Appointment Reminder Letter - Spanish	IC Document
Appendix C27 NAMES Survey Income Source Show Card.docx Appendix C27 NAMES Survey Income Source Show Card	IC Document
Appendix C28 NAMES Survey Income Source Show Card_Spanish.docx Appendix C28 NAMES Survey Income Source Show Card - Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Individuals/Households

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix B20 NAMES Recruitment Call Script	Appendix B20 NAMES Recruitment Call Script.docx	Yes	Yes	Fillable Fileable
Other-Appendix B21 NAMES Recruitment Call Script - Spanish	Appendix B21 NAMES Recruitment Call Script_Spanish.docx	Yes	Yes	Fillable Fileable
Other-Appendix C19 NAMES Survey Consent Form	Appendix C19 NAMES Survey Consent Form.docx	No		Paper Only
Other-Appendix C20 NAMES Survey Consent Form - Spanish	Appendix C20 NAMES Survey Consent Form-Spanish.docx	No		Paper Only
Other-Appendix C23 NAMES Survey Income Worksheet	Appendix C23 NAMES Survey Income Worksheet.docx	No		Paper Only
Other-Appendix C24 NAMES Survey Income Worksheet - Spanish	Appendix C24 NAMES Survey Income Worksheet_Spanish.docx	No		Paper Only
Other-Appendix C25 NAMES Survey	Appendix C25 NAMES Survey.docx	Yes	Yes	Fillable Fileable
Other-Appendix C26 NAMES Survey - Spanish	Appendix C26 NAMES Survey_Spanish.docx	Yes	Yes	Fillable Fileable
Other-Appendix C29 NAMES Survey Incentive Received Form	Appendix C29 NAMES Survey Incentive Received Form.doc	No		Paper Only
Other-Appendix C30 NAMES Survey Incentive Received Form - Spanish	Appendix C30 NAMES Survey Incentive Received Form_Spanish.doc	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: 56 FR 19078

Number of Respondents: 6,767

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51,992	51,992
Annual IC Time Burden (Hours)	9,152	9,152
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix B16 NAMES Introductory Letter	Appendix B16 NAMES Introductory Letter.docx	06/21/2016
Appendix B17 NAMES Introductory Letter - Spanish	Appendix B17 NAMES Introductory Letter_Spanish.docx	06/21/2016
Appendix B18 NAMES Brochure	Appendix B18 NAMES Brochure.docx	06/21/2016
Appendix B19 NAMES Brochure - Spanish	Appendix B19 NAMES Brochure-Spanish.docx	06/21/2016
Appendix C21 NAMES Appointment Reminder Letter	Appendix C21 NAMES Appointment Reminder Letter.docx	06/22/2016
Appendix C22 NAMES Appointment Reminder Letter - Spanish	Appendix C22 NAMES Appointment Reminder Letter_Spanish.docx	06/22/2016
Appendix C27 NAMES Survey Income Source Show Card	Appendix C27 NAMES Survey Income Source Show Card.docx	06/22/2016
Appendix C28 NAMES Survey Income Source Show Card - Spanish	Appendix C28 NAMES Survey Income Source Show Card_Spanish.docx	06/22/2016

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