Information Collection

CPS Food Security Supplement

IC 236084 under ICR 201606-0607-003 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Protocol and Questionnaire CPS Food Security Supplement	Form and Instruction
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

IC Title:

CPS Food Security Supplement

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1				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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo		05/14/2019
Recruitment Ads		05/14/2019
Consent Form		05/14/2019
Additional Screener Questions		05/14/2019
Recruitment Flier		05/14/2019
Voucher Form		05/14/2019

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

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