Information Collection

Household Survey Activities

IC 228202 under ICR 201709-0584-001 · OMB 0584-0638.

Documents and Forms

Documents and forms in this information collection
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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.