Information Collection

Respondents Individuals/Households - Elderly 60+

IC 228206 under ICR 201708-0584-003 · OMB 0584-0637.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0637 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attch H.1_Elderly Participant Interview Guide.docx	Other-Attachment H.1_Elderly Partici
Attch H.1.a_Elderly Participant Interview Guide_Spanish.docx	Other-Attachment H.1.a_Elderly Parti
Attch H.2_Elderly Participant Focus Group Guide.docx	Other-Attachment H.2_Elderly Partici
Attch D.5_Interview Screen Form.docx	Other-Attch D.5_Interview Screen For
Attch D.5.a Int Screen Form_Spanish 10-16-17.docx	Other-Attachment D.5.a Int Screen Fo
Attch D.2_Int Recruitment Flyer 9-13-17.docx Attachment D.2_Int Recruitment Flyer 9-13-17.docx	IC Document
Attch D.2.a_Int Flyer_Spanish 9-13-17.docx Attachment D.2.a_Int Flyer_Spanish 9-13-17.docx	IC Document
Attch D.3_Recruit Script 10-16-17.docx Attch D.3_Recruit Script 10-16-17.docx	IC Document
Attch D.3.a_Recruit Script_Spanish 10-16-17.docx Attch D.3.a_Recruit Script_Spanish 10-16-17.docx	IC Document
Attch D.4_Focus Recruitment Flyer 9-13-17.docx Attachment D.4_Focus Recruitment Flyer 9-13-17.docx	IC Document
Attch D.6_Interview Consent Form 9-13-17.docx Attachment D.6_Interview Consent Form 9-13-17.docx	IC Document
Attch D.6a_Int Consent Form_Spanish 9-13-17.docx Attachment D.6a_Int Consent Form_Spanish 9-13-17.docx	IC Document
Attch D.7_Focus Consent Form.docx Attachment D.7_Focus Consent Form.docx	IC Document

IC Title:

Respondents Individuals/Households - Elderly 60+

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	Available Electronically?	Electronic Capability
Other-Attachment H.1_Elderly Participant Interview Guide.docx	Attch H.1_Elderly Participant Interview Guide.docx	No	Paper Only
Other-Attachment H.1.a_Elderly Participant Interview Guide_Spanish.docx	Attch H.1.a_Elderly Participant Interview Guide_Spanish.docx	No	Paper Only
Other-Attachment H.2_Elderly Participant Focus Group Guide.docx	Attch H.2_Elderly Participant Focus Group Guide.docx	No	Paper Only
Other-Attch D.5_Interview Screen Form 10-16-17.docx	Attch D.5_Interview Screen Form.docx	No	Paper Only
Other-Attachment D.5.a Int Screen Form_Spanish.docx	Attch D.5.a Int Screen Form_Spanish 10-16-17.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-9 STARS

FR Citation: 75 FR 81207

Number of Respondents: 366

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	566	566
Annual IC Time Burden (Hours)	395	395
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D.2_Int Recruitment Flyer 9-13-17.docx	Attch D.2_Int Recruitment Flyer 9-13-17.docx	09/28/2017
Attachment D.2.a_Int Flyer_Spanish 9-13-17.docx	Attch D.2.a_Int Flyer_Spanish 9-13-17.docx	09/28/2017
Attch D.3_Recruit Script 10-16-17.docx	Attch D.3_Recruit Script 10-16-17.docx	10/16/2017
Attch D.3.a_Recruit Script_Spanish 10-16-17.docx	Attch D.3.a_Recruit Script_Spanish 10-16-17.docx	10/16/2017
Attachment D.4_Focus Recruitment Flyer 9-13-17.docx	Attch D.4_Focus Recruitment Flyer 9-13-17.docx	09/28/2017
Attachment D.6_Interview Consent Form 9-13-17.docx	Attch D.6_Interview Consent Form 9-13-17.docx	09/28/2017
Attachment D.6a_Int Consent Form_Spanish 9-13-17.docx	Attch D.6a_Int Consent Form_Spanish 9-13-17.docx	09/28/2017
Attachment D.7_Focus Consent Form.docx	Attch D.7_Focus Consent Form.docx	09/28/2017

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