Information Collection

State Agency Respondents

IC 218671 under ICR 201807-0584-002 · OMB 0584-0604.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
H_Master Site Visit Protocol.docx	Other-H_Master Site Visit Protocol.d
I.2_Interview Guide for Providers.docx	Other-I.1_Interview Guide for provid
J.3_Focus Group Moderator Guide for Employers.docx	Other-J.3_Focus Group Moderator Guid
M.3_Participant Information Survey - Employer.docx	Other-M.3_Participant Information Su
V.1_Time Use Survey.docx	Other-V.1_Time Use Survey.docx
V.2_Time-Use Survey_ScreenShots.docx	Other-V.2_Time-Use Survey_ScreenShot
I.3_Observation Guide.docx I.3_Observation Guide.docx	IC Document
L.3_Focus Group Recruitment Email - Employer.docx L.3_Focus Group Recruitment Email - Employer.docx	IC Document
L.4_Focus Group Confirmation Letter - Employer.docx L.4_Focus Group Confirmation Letter - Employer.docx	IC Document
T_Administrative Data Items.docx T_Administrative Data Items.docx	IC Document
U_Master Pilot Costs Workbook.xlsx U_Master Pilot Costs Workbook.xlsx	IC Document
W.1_Time Use Survey Initial Email.docx W.1_Time Use Survey Initial Email.docx	IC Document
W.2_Time Use Survey Reminder Email.docx W.2_Time Use Survey Reminder Email.docx	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	URL	Available Electronically?	Electronic Capability
Other-H_Master Site Visit Protocol.docx		No	Paper Only
Other-I.1_Interview Guide for providers.docx		No	Paper Only
Other-J.3_Focus Group Moderator Guide for Employers.docx		No	Paper Only
Other-M.3_Participant Information Survey - Employer.docx		No	Paper Only
Other-V.1_Time Use Survey.docx		No	Paper Only
Other-V.2_Time-Use Survey_ScreenShots.docx	CATI at MPR	No	Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: USDA/FNS-10 Persons Doing Business with the Food and Nutrition Service,

FR Citation: 65 FR 17252

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	620	-480	1,100
Annual IC Time Burden (Hours)	1,105	-480	1,585
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
I.3_Observation Guide.docx		12/17/2018
L.3_Focus Group Recruitment Email - Employer.docx		12/17/2018
L.4_Focus Group Confirmation Letter - Employer.docx		12/17/2018
T_Administrative Data Items.docx		12/17/2018
U_Master Pilot Costs Workbook.xlsx		12/17/2018
W.1_Time Use Survey Initial Email.docx		12/17/2018
W.2_Time Use Survey Reminder Email.docx		12/17/2018

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

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