Information Collection

Respondents- Individuals/Households (Parents/Children/Teens)

IC 229043 under ICR 201711-0584-003 · OMB 0584-0635.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
G2. Household Eligibility Screener.docx www.notyetcreated.com	Other-G2. Household Eligibility Scre
G2.A Household Eligibility Screener web.docx www.notyetcreated.com	Other-G2.A Household Eligibility Scr
G6. Telephone Follow-Up Script for Caregivers.docx	Other-G6. Telephone Follow-Up Script
G7. Caregiver Survey_2.16.18.docx	Other-G7. Caregiver Survey.docx
G7.A Caregiver Survey web.docx www.notyetcreated.com	Other-G7.A Caregiver Survey web.docx
G8 Child survey.docx	Other-G8. Child Participant Survey.d
G8.A Child Participant Survey web.docx www.notyetcreated.com	Other-G8.A Child Participant Survey
G9. Teen Survey.docx	Other-G9. Teen Survey.docx
G9.A Teen Survey web.docx www.notyetcreated.com	Other-G9.A Teen Survey web.docx
G11. Telephone Script to Schedule Caregiver Key Informant Interview.docx	Other-G11. Telephone Script to Sched
G12. Participant caregiver QI.docx	Other-G12. Participant Caregiver KII
G13. Nonparticipant caregiver QI.docx	Other-G13. Nonparticipant caregiver
H7. Participant Caregiver Survey and Screener Pretest Protocol.docx	Other-H7. Participant Caregiver Surv
H8. Nonparticipant Caregiver Survey and Screener Pretest Protocol.docx	Other-H8. Nonparticipant Caregiver S
H9. Child Participant Survey Pretest Protocol.docx	Other-H9. Child Participant Survey P
H10. Teen Participant Survey Pretest Protocol.docx	Other-H10. Teen Participant Survey P
H11. Teen Nonparticipant Survey Pretest Protocol.docx	Other-H11. Teen Nonparticipant Surve
H12. Participant Caregiver Key Informant Interview Pretest Protocol.docx	Other-H12. Participant Caregiver Key
H13. Nonparticipant Caregiver Key Informant Interview Pretest Protocol.docx	Other-H13. Nonparticipant Caregiver
G1. Household Screener Invitation Letter.docx G1. Household Screener Invitation Letter.docx	IC Document
G3. Invitation Letter for Mailed Surveys.docx G3. Invitation Letter for Mailed Surveys.docx	IC Document
G4. Reminder Postcard to Eligible Caregivers.docx G4. Reminder Postcard to Eligible Caregivers.docx	IC Document
G5. Invitation letter to onsite participants.docx G5. Invitation letter to onsite participants.docx	IC Document
G10. Study Thank You With Incentives (All Caregivers).docx G10. Study Thank You With Incentives (All Caregivers).docx	IC Document
G14. Key Informant Interview Thank You with Incentive (Caregivers).docx G14. Key Informant Interview Thank You with Incentive (Caregivers).docx	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Respondents- Individuals/Households (Parents/Children/Teens)

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-G7. Caregiver Survey.docx	G7. Caregiver Survey_2.16.18.docx		No		Paper Only
Other-H7. Participant Caregiver Survey and Screener Pretest Protocol.docx	H7. Participant Caregiver Survey and Screener Pretest Protocol.docx		No		Paper Only
Other-H8. Nonparticipant Caregiver Survey and Screener Pretest Protocol.docx	H8. Nonparticipant Caregiver Survey and Screener Pretest Protocol.docx		No		Paper Only
Other-H9. Child Participant Survey Pretest Protocol.docx	H9. Child Participant Survey Pretest Protocol.docx		No		Paper Only
Other-H10. Teen Participant Survey Pretest Protocol.docx	H10. Teen Participant Survey Pretest Protocol.docx		No		Paper Only
Other-H11. Teen Nonparticipant Survey Pretest Protocol.docx	H11. Teen Nonparticipant Survey Pretest Protocol.docx		No		Paper Only
Other-H12. Participant Caregiver Key Informant Interview Pretest Protocol.docx	H12. Participant Caregiver Key Informant Interview Pretest Protocol.docx		No		Paper Only
Other-H13. Nonparticipant Caregiver Key Informant Interview Pretest Protocol.docx	H13. Nonparticipant Caregiver Key Informant Interview Pretest Protocol.docx		No		Paper Only
Other-G2. Household Eligibility Screener.docx	G2. Household Eligibility Screener.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-G2.A Household Eligibility Screener web.docx	G2.A Household Eligibility Screener web.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-G6. Telephone Follow-Up Script for Caregivers.docx	G6. Telephone Follow-Up Script for Caregivers.docx		No		Paper Only
Other-G7.A Caregiver Survey web.docx	G7.A Caregiver Survey web.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-G8. Child Participant Survey.docx	G8 Child survey.docx		No		Paper Only
Other-G8.A Child Participant Survey web.docx	G8.A Child Participant Survey web.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-G9. Teen Survey.docx	G9. Teen Survey.docx		No		Paper Only
Other-G9.A Teen Survey web.docx	G9.A Teen Survey web.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-G11. Telephone Script to Schedule Caregiver Key Informant Interview.docx	G11. Telephone Script to Schedule Caregiver Key Informant Interview.docx		No		Paper Only
Other-G12. Participant Caregiver KII Discussion Guide.docx	G12. Participant caregiver QI.docx		No		Paper Only
Other-G13. Nonparticipant caregiver QI.docx	G13. Nonparticipant caregiver QI.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: 24,568

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	230,855	230,855
Annual IC Time Burden (Hours)	16,504	16,504
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
G1. Household Screener Invitation Letter.docx	G1. Household Screener Invitation Letter.docx	11/17/2017
G3. Invitation Letter for Mailed Surveys.docx	G3. Invitation Letter for Mailed Surveys.docx	11/17/2017
G4. Reminder Postcard to Eligible Caregivers.docx	G4. Reminder Postcard to Eligible Caregivers.docx	11/17/2017
G5. Invitation letter to onsite participants.docx	G5. Invitation letter to onsite participants.docx	11/17/2017
G10. Study Thank You With Incentives (All Caregivers).docx	G10. Study Thank You With Incentives (All Caregivers).docx	11/17/2017
G14. Key Informant Interview Thank You with Incentive (Caregivers).docx	G14. Key Informant Interview Thank You with Incentive (Caregivers).docx	11/17/2017

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