Information Collection

State, Local and Tribal Agencies (Respondents)

IC 228063 under ICR 201708-0584-002 · OMB 0584-0633.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment C.1. National Survey of State SNAP Data Matching, State-Level Survey.docx www.qualtrics.com	Other-Attachment C.1. National Surve
Attachment C.2 National Survey of State SNAP Data Matching, County-Level Survey.docx www.qualtrics.com	Other-Attachment C.2 National Survey
Attachment D. Screen Shot of Web Survey.docx www.qualtrics.com	Other-Attachment D. Screen Shot of W
Attachment E. Introduction letter to regional directors of upcoming study.docx Attachment E. Introduction letter to regional directors of upcoming study.docx	IC Document
Attachment G. Introduction letter to State SNAP directors of upcoming study.docx Attachment G. Introduction letter to State SNAP directors of upcoming study.docx	IC Document
Attachment I. Letter to State administrative staff to participate in survey.docx Attachment I. Letter to State administrative staff to participate in survey.docx	IC Document
Attachment M. Follow-up Email.docx Attachment M. Follow-up Email.docx	IC Document
Attachment N. Follow-up Telephone Script.docx Attachment N. Follow-up Telephone Script.docx	IC Document

IC Title:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment C.1. National Survey of State SNAP Data Matching, State-Level Survey.docx	Attachment C.1. National Survey of State SNAP Data Matching, State-Level Survey.docx	www.qualtrics.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment C.2 National Survey of State SNAP Data Matching, County-Level Survey.docx	Attachment C.2 National Survey of State SNAP Data Matching, County-Level Survey.docx	www.qualtrics.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment D. Screen Shot of Web Survey.docx	Attachment D. Screen Shot of Web Survey.docx	www.qualtrics.com	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 221

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	221	221
Annual IC Time Burden (Hours)	181	181
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment E. Introduction letter to regional directors of upcoming study.docx	Attachment E. Introduction letter to regional directors of upcoming study.docx	08/29/2017
Attachment G. Introduction letter to State SNAP directors of upcoming study.docx	Attachment G. Introduction letter to State SNAP directors of upcoming study.docx	08/29/2017
Attachment I. Letter to State administrative staff to participate in survey.docx	Attachment I. Letter to State administrative staff to participate in survey.docx	08/29/2017
Attachment M. Follow-up Email.docx	Attachment M. Follow-up Email.docx	08/29/2017
Attachment N. Follow-up Telephone Script.docx	Attachment N. Follow-up Telephone Script.docx	08/29/2017

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