Household Survey Activities

Study of Non-Response to the School Meals Application Verification Process

OMB: 0584-0638

IC ID: 228202

Documents and Forms

Document Name Document Type
12a. Household Survey_English.docx Other-Appendix 12.a Household Survey
12b. Household Survey_Spanish.docx Other-Appendix 12.b Household Survey
29a. Household survey call script-English.docx Other-Appendix 29.a Household Survey
29b. Household survey call script-Spanish.docx Other-Appendix 29.b Household Survey
37. Respondent Payment Log.docx Other-Appendix 37 Respondent Payment
20a. Household survey advance letter_English.docx Appendix 20.a Household Survey Advance Letter - English IC Document
20b. Household survey advance letter_Spanish.docx Appendix 20.b Household Survey Advance Letter - Spanish IC Document
21a. Household Survey Brochure (English).pdf Appendix 21.a Household Survey Brochure - English IC Document
21b. Household Survey Brochure (Spanish).pdf Appendix 21.b Household Survey Brochure - Spanish IC Document
22a. Household survey frequently asked questions (English).docx Appendix 22.a Household Survey Frequently Asked Questions - English IC Document
22b. Household survey frequently asked questions (Spanish).docx Appendix 22.b Household Survey Frequently Asked Questions - Spanish IC Document
33a. Household Survey Thank you letter_English.docx Appendix 33.a Household Survey Thank You Letter - English IC Document
33b. Household Survey Thank you letter_Spanish.docx Appendix 33.b Household Survey Thank You Letter - Spanish IC Document
40a. Household Survey Door Hanger (English).pdf Appendix 40.a Household Survey Door Hanger - English IC Document
40b. Household Survey Door Hanger (Spanish).pdf Appendix 40.b Household Survey Door Hanger - Spanish IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Household Survey Activities	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 245.6a

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix 12.a Household Survey - English	12a. Household Survey_English.docx	Yes	Yes	Fillable Fileable
Other-Appendix 12.b Household Survey - Spanish	12b. Household Survey_Spanish.docx	Yes	Yes	Fillable Fileable
Other-Appendix 29.a Household Survey Call Script - English	29a. Household survey call script-English.docx	No		Paper Only
Other-Appendix 29.b Household Survey Call Script - Spanish	29b. Household survey call script-Spanish.docx	No		Paper Only
Other-Appendix 37 Respondent Payment Log	37. Respondent Payment Log.docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: FNS-8 USDA/FNS Studies and Reports	FR Citation: 56 FR 19078

Number of Respondents: 1,486	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11,846	11,846
Annual IC Time Burden (Hours)	5,123	5,123
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix 20.a Household Survey Advance Letter - English	20a. Household survey advance letter_English.docx	09/15/2017
Appendix 20.b Household Survey Advance Letter - Spanish	20b. Household survey advance letter_Spanish.docx	09/15/2017
Appendix 21.a Household Survey Brochure - English	21a. Household Survey Brochure (English).pdf	09/15/2017
Appendix 21.b Household Survey Brochure - Spanish	21b. Household Survey Brochure (Spanish).pdf	09/15/2017
Appendix 22.a Household Survey Frequently Asked Questions - English	22a. Household survey frequently asked questions (English).docx	09/15/2017
Appendix 22.b Household Survey Frequently Asked Questions - Spanish	22b. Household survey frequently asked questions (Spanish).docx	09/15/2017
Appendix 33.a Household Survey Thank You Letter - English	33a. Household Survey Thank you letter_English.docx	09/15/2017
Appendix 33.b Household Survey Thank You Letter - Spanish	33b. Household Survey Thank you letter_Spanish.docx	09/15/2017
Appendix 40.a Household Survey Door Hanger - English	40a. Household Survey Door Hanger (English).pdf	09/15/2017
Appendix 40.b Household Survey Door Hanger - Spanish	40b. Household Survey Door Hanger (Spanish).pdf	09/15/2017

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