Food and Nutrition Service (FNS) Form Cognitive Testing

Generic Clearance for Internet Nonprobability Panel Pretesting

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0978 can be found here:

Documents and Forms

Document Name Document Type
FNS_PROTOCOL_PROTOYPE_APPLICANT_V5.docx Instruction
FNS_PROTOCOL_ADMIN_V2.docx Instruction
2016-2017 Prototyp 2016-2017 Prototype Household Application for Free and R FNS 2016-2017 Household Application Form.pdf Form
FNS OMB Memo v2.docx Memo IC Document
FNS FAQ.pdf FAQs IC Document
FNS Instructions.pdf Instructions IC Document
FNS Consent Form.docx Consent Form IC Document
FNS_APPLICANT_SCREENER_ADDL_QUESTIONS.docx Screener IC Document

Information Collection (IC) Details

IC Title:	Food and Nutrition Service (FNS) Form Cognitive Testing	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			FNS_PROTOCOL_PROTOYPE_APPLICANT_V5.docx	Yes	Yes	Paper Only
Instruction			FNS_PROTOCOL_ADMIN_V2.docx	Yes	Yes	Paper Only
Form	2016-2017 Prototype Household Application	2016-2017 Prototype Household Application for Free and Reduced Price School Meals	FNS 2016-2017 Household Application Form.pdf	Yes	Yes	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	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	180	180
Annual IC Time Burden (Hours)	293	293
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Memo	FNS OMB Memo v2.docx	08/03/2016
FAQs	FNS FAQ.pdf	08/03/2016
Instructions	FNS Instructions.pdf	08/03/2016
Consent Form	FNS Consent Form.docx	08/03/2016
Screener	FNS_APPLICANT_SCREENER_ADDL_QUESTIONS.docx	08/03/2016

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