CPS Food Security Supplement

Generic Clearance for Questionnaire Pretesting Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

Documents and Forms

Document Name Document Type
Form 1 CPS Food Security Supplement Form and Instructi
1 Protocol and Questionnaire Attachment II CPS_FSS_Protocol_Questionnaire.doc Form and Instruction
CPS FSS OMB Memo.docx OMB Memo IC Document
Attachment I CPS Combo Ad_BOC Email and Craigslist.docx Recruitment Ads IC Document
Attachment III Consent Form.doc Consent Form IC Document
Attachment IV Recruitment Eligibility Screeners.docx Additional Screener Questions IC Document
Attachment V CPS Flyer 2019 flyer.pdf Recruitment Flier IC Document
Attachment VI voucherform.doc Voucher Form IC Document

Information Collection (IC) Details

IC Title:	CPS Food Security Supplement	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Protocol and Questionnaire	Attachment II CPS_FSS_Protocol_Questionnaire.doc		No		Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo	CPS FSS OMB Memo.docx	05/14/2019
Recruitment Ads	Attachment I CPS Combo Ad_BOC Email and Craigslist.docx	05/14/2019
Consent Form	Attachment III Consent Form.doc	05/14/2019
Additional Screener Questions	Attachment IV Recruitment Eligibility Screeners.docx	05/14/2019
Recruitment Flier	Attachment V CPS Flyer 2019 flyer.pdf	05/14/2019
Voucher Form	Attachment VI voucherform.doc	05/14/2019

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