Information Collection

Individual/Households Respondents

IC 218669 under ICR 201807-0584-002 · OMB 0584-0604.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
C.1_Registration Document_English.docx	Other-C.1_Registration Document_Engl
C.2_Registration Document_Spanish.docx	Other-C.2_Registration Document_Span
C.3_Registration Document Screenshots.docx	Other-C.3_Registration Document Scre
D.1_Study Consent Document_English.docx	Other-D.1_Study Consent Document_Eng
D.2_Study Consent Document_Spanish.docx	Other-D.2_Study Consent Document_Spa
D.3_Study Consent Document_Mandatory_English.docx	Other-D.3_Study Consent Document_Man
D.4_Study Consent Document_Mandatory_Spanish.docx	Other-D.4_Study Consent Document_Man
I.1_Interview Guide for Clients.docx	Other-I.1_Interview Guide for Client
J.1_Focus Group Moderator Guide for Clients-English.docx	Other-J.1_Focus Group Moderator Guid
J.2_Focus Group Moderator Guide for Clients-Spanish.docx	Other-J.2_Focus Group Moderator Guid
K.1_Focus Group Recruitment Guide - English.docx	Other-K.1_Focus Group Recruitment Gu
K.2_Focus Group Recruitment Guide - Spanish.docx	Other-K.2_Focus Group Recruitment Gu
M.1_Participant Information Survey - English 2-21-2019.docx	Other-M.1_Participant Information Su
M.2_Participant Information Survey - Spanish 2-21-19.docx	Other-M.2_Participant Information Su
O.1_SNAP E&T Pilots 12-Month FollowUp Survey_English.pdf	Other-O.1_SNAP E&T Pilots 12-Month F
O.2_SNAP E&T Pilots 12-Month FollowUp Survey_Spanish.pdf	Other-O.2_SNAP E&T Pilots 12-Month F
O.3_Screenshot 12-month FU Survey.docx CATI at MPR	Other-O.3_Screenshot 12-month FU Sur
O.4_SNAP E&T Pilots 36-Month FollowUp Survey_English.pdf	Other-O.4_SNAP E&T Pilots 36-Month F
O.5_SNAP E&T Pilots 36-Month FollowUp Survey_Spanish.pdf	Other-O.5_SNAP E&T Pilots 36-Month F
O.6_Screenshot 36-month FU Survey.docx CATI at MPR	Other-O.6_Screenshot 36-month FU Sur
E.1_WelcomePacketLetter_English_Final.docx E.1_WelcomePacketLetter_English_Final.docx	IC Document
E.2_WelcomePacketLetter_Spanish_Final.docx E.2_WelcomePacketLetter_Spanish_Final.docx	IC Document
F.1_Study Brochure_English.docx F.1_Study Brochure_English.docx	IC Document
F.2_Study Brochure_Spanish.docx F.2_Study Brochure_Spanish.docx	IC Document
G.1_Seasonal Postcard_English.docx G.1_Seasonal Postcard_English.docx	IC Document
G.2_Seasonal Postcard_Spanish.docx G.2_Seasonal Postcard_Spanish.docx	IC Document
L.1_Focus Group Confirmation Letter - English.docx L.1_Focus Group Confirmation Letter - English.docx	IC Document
L.2_Focus Group Confirmation Letter - Spanish.docx L.2_Focus Group Confirmation Letter - Spanish.docx	IC Document
P.1_Survey Advance Letter_English.docx P.1_Survey Advance Letter_English.docx	IC Document
P.2_Survey Advance Letter_Spanish.docx P.2_Survey Advance Letter_Spanish.docx	IC Document
Q.1_Survey Reminder Letter_English.docx Q.1_Survey Reminder Letter_English.docx	IC Document
Q.2_Survey Reminder Letter_Spanish.docx Q.2_Survey Reminder Letter_Spanish.docx	IC Document
R.1_Survey Reminder Postcard_English 12-17-18.docx R.1_Survey Reminder Postcard_English.docx	IC Document
R.2_Survey Reminder Postcard_Spanish 12-17-2018.docx R.2_Survey Reminder Postcard_Spanish.docx	IC Document
S.1_RefusalLetter_English12-17-18.docx S.1_RefusalLetter_English.docx	IC Document
S.2_RefusalLetter_Spanish.docx S.2_RefusalLetter_Spanish.docx	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Individual/Households Respondents

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-C.1_Registration Document_English.docx	C.1_Registration Document_English.docx		No		Paper Only
Other-C.2_Registration Document_Spanish.docx	C.2_Registration Document_Spanish.docx		No		Paper Only
Other-C.3_Registration Document Screenshots.docx	C.3_Registration Document Screenshots.docx		Yes	Yes	Fillable Fileable Signable
Other-D.1_Study Consent Document_English.docx	D.1_Study Consent Document_English.docx		No		Paper Only
Other-D.2_Study Consent Document_Spanish.docx	D.2_Study Consent Document_Spanish.docx		No		Paper Only
Other-D.3_Study Consent Document_Mandatory_English.docx	D.3_Study Consent Document_Mandatory_English.docx		No		Paper Only
Other-D.4_Study Consent Document_Mandatory_Spanish.docx	D.4_Study Consent Document_Mandatory_Spanish.docx		No		Paper Only
Other-I.1_Interview Guide for Clients.docx	I.1_Interview Guide for Clients.docx		No		Paper Only
Other-J.1_Focus Group Moderator Guide for Clients-English.docx	J.1_Focus Group Moderator Guide for Clients-English.docx		No		Paper Only
Other-J.2_Focus Group Moderator Guide for Clients-Spanish.docx	J.2_Focus Group Moderator Guide for Clients-Spanish.docx		No		Paper Only
Other-K.1_Focus Group Recruitment Guide - English.docx	K.1_Focus Group Recruitment Guide - English.docx		No		Paper Only
Other-K.2_Focus Group Recruitment Guide - Spanish.docx	K.2_Focus Group Recruitment Guide - Spanish.docx		No		Paper Only
Other-M.1_Participant Information Survey - English.docx	M.1_Participant Information Survey - English 2-21-2019.docx		No		Paper Only
Other-M.2_Participant Information Survey - Spanish.docx	M.2_Participant Information Survey - Spanish 2-21-19.docx		No		Paper Only
Other-O.1_SNAP E&T Pilots 12-Month FollowUp Survey_English.pdf	O.1_SNAP E&T Pilots 12-Month FollowUp Survey_English.pdf		No		Paper Only
Other-O.2_SNAP E&T Pilots 12-Month FollowUp Survey_Spanish.pdf	O.2_SNAP E&T Pilots 12-Month FollowUp Survey_Spanish.pdf		No		Paper Only
Other-O.3_Screenshot 12-month FU Survey.docx	O.3_Screenshot 12-month FU Survey.docx	CATI at MPR	No		Fillable Fileable Signable
Other-O.4_SNAP E&T Pilots 36-Month FollowUp Survey_English.pdf	O.4_SNAP E&T Pilots 36-Month FollowUp Survey_English.pdf		No		Paper Only
Other-O.5_SNAP E&T Pilots 36-Month FollowUp Survey_Spanish.pdf	O.5_SNAP E&T Pilots 36-Month FollowUp Survey_Spanish.pdf		No		Paper Only
Other-O.6_Screenshot 36-month FU Survey.docx	O.6_Screenshot 36-month FU Survey.docx	CATI at MPR	Yes	Yes	Fillable Printable

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: 11,090

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	Previously Approved
Annual Number of Responses for this IC	46,002	-91,301	137,303
Annual IC Time Burden (Hours)	6,759	-22,719	29,478
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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