OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

National Food Study Pilot

IC 223174 under ICR 201608-0536-001 · OMB 0536-0074.

Documents and Forms
Document Name
Document Type
Other-Household Screener_Spanish Ver
Other-Initial Interview_English vers
Other-Initial Interview_Spanish vers
Other-Food Log_English Version
Other-Food Log_Spanish Version
Other-Income Worksheet_English Versi
Other-Income Worksheet_Spanish Versi
Other-Meals and Snacks Form_English
Other-Meals and Snacks Form_Spanish
Other-Nonresponse Followup_English V
Other-Nonresponse Followup_Spanish V
Other-Final Interview _English Versi
Other-Final Interview _Spanish Versi
Other-Respondent Feedback_English Ve
Other-Respondent Feedback_Spanish Ve
Other-Recall Interview_English Versi
Other-Household Screener_English Ver
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

National Food Study Pilot
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Household Screener_Spanish Version B1a Household Screener_Spanish.docx Yes Yes Fillable Fileable
Other-Initial Interview_English version B2 Initial Interview.docx Yes Yes Fillable Fileable
Other-Initial Interview_Spanish version B2a Initial Interview_Spanish .docx Yes Yes Fillable Fileable
Other-Food Log_English Version B3 Food Log.docx Yes Yes Fillable Fileable
Other-Food Log_Spanish Version B3a Food Log_Spanish.docx Yes Yes Fillable Fileable
Other-Income Worksheet_English Version B4 Income Worksheet.docx Yes Yes Fillable Fileable
Other-Income Worksheet_Spanish Version B4a Income Worksheet_Spanish.docx Yes Yes Fillable Fileable
Other-Meals and Snacks Form_English Version B5 Meals and Snacks Form.docx Yes Yes Fillable Fileable
Other-Meals and Snacks Form_Spanish Version B5a Meals and Snacks Form_Spanish.docx Yes Yes Fillable Fileable
Other-Nonresponse Followup_English Version B6 Nonresponse Followup.docx Yes Yes Fillable Fileable
Other-Nonresponse Followup_Spanish Version B6a Nonresponse Followup_Spanish.docx Yes Yes Fillable Fileable
Other-Final Interview _English Version B7 Final Interview.docx Yes Yes Fillable Fileable
Other-Final Interview _Spanish Version B7a Final Interview_Spanish.docx Yes Yes Fillable Fileable
Other-Respondent Feedback_English Version B8 Respondent Feedback.docx Yes Yes Fillable Fileable
Other-Respondent Feedback_Spanish Version B8a Respondent Feedback_Spanish.docx Yes Yes Fillable Fileable
Other-Recall Interview_English Version B9 Recall Interview.docx Yes Yes Fillable Fileable
Other-Household Screener_English Version B1 Household Screener.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

2,500 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,500 0 2,500 0 0 0
Annual IC Time Burden (Hours) 6,575 0 6,575 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
A6 Westat Confidentiality and Nondisclousure Agreement A6 Westat Confidentiality and Nondisclousure Agreement.pdf 08/24/2016
A7 Westat IRB Approval A7 Westat IRB Approval.docx 08/24/2016
A8a 60 Day FRN A8a 60 Day FRN.pdf 08/24/2016
A9 Pretest Report A9 Pretest Report.pdf 09/21/2016
ERS Response to NASS Comments Response to NASS Comments 081116.docx 08/24/2016
A1 Advance letter_English Version A1 Advance letter.docx 09/21/2016
A1a Advance letter_Spanish Version A1a Advance letter_Spanish.doc 09/21/2016
A2 Information Sheet_English Version A2 Information Sheet _English_09212016.doc 09/21/2016
A2a Information Sheet_Spanish Version A2a Information Sheet _Spanish.doc 09/21/2016
A5a Parental Consent Form_English Version A5a Parental Consent Form.docx 09/21/2016
A5b Individual Assent-Consent Form_English Version A5b Individual Assent-Consent Form.docx 09/21/2016
A5ba Individual Assent-Consent Form_Spanish Version A5ba Individual Assent-Consent Form_Spanish.doc 09/21/2016
A3 Disclaimer A3 Disclaimer.docx 12/06/2016
A3a Disclaimer_Spanish A3a Disclaimer_Spanish.doc 12/06/2016
A4 Consent Form_English Version A4 Consent Form.docx 12/06/2016
A4a Consent Form_Spanish Version A4a Consent Form_Spanish.doc 12/06/2016
A5a Parental Consent Form_English Version A5a Parental Consent Form.docx 12/06/2016
A5aa Parental Consent Form_Spanish A5aa Parental Consent Form_Spanish.doc 12/06/2016
ERS respose to omb passback ERS respose to omb passback.docx 12/06/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.