Information Collection

Usability Testing of the FNS SNAP Application

IC 237849 under ICR 201812-0607-001 · OMB 0607-0978.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0978 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Usability Testing of the FNS SNAP Application	Form and Instruction
1 Indiana SNAP Application Food Supplement Program-Paper Application Indiana_enclosure 2.pdf	Form and Instruction
2 Massachusetts SNAP Application Food Supplement Program-Paper Application MA_enclosure 2.pdf	Form and Instruction
3 Maryland SNAP Application Food Supplement Program-Paper Application MD_enclosure 2.pdf	Form and Instruction
4 Oklahoma SNAP Application Food Supplement Program-Paper Application Oklahoma_enclosure 2.pdf	Form and Instruction
5 Virginia SNAP Application Food Supplement Program-Paper Application VA_enclosure 2.pdf	Form and Instruction
6 MD_ScreenShots_1-50 MD_Scrren Shots 1-50.pdf	Form and Instruction
7 MD_Screenshot_51-100 MD_Screenshots 51-100.pdf	Form and Instruction
8 MD_Screenshots_101-150 MD_Screenshot 101-150.pdf	Form and Instruction
9 MD_Screenshots_151-181 MD_Screenshots 151-181.pdf	Form and Instruction
protocol enclosure 1.docx Protocol	IC Document
demographic questionnaire enclosure 3.docx Demographic Quesitonnaire	IC Document
Mobile devise use questionnaire_enclosure 4.docx Mobile Device Use Questionnaire	IC Document
Satisfaction questionnaire_enclosure 5.docx Satisfaction Questionnaire	IC Document
additional screener question enclosure 6.docx Additional Screener Questions	IC Document
FNS - Usability Test Plan 8.19.19_enclosure 7.docx Testing Plan	IC Document
omb letter_fns_v2.pdf OMB Memo	IC Document

IC Title:

Usability Testing of the FNS SNAP Application

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	4	Oklahoma SNAP Application	Food Supplement Program-Paper Application Oklahoma_enclosure 2.pdf	No	Fillable Fileable
Form and Instruction	9	MD_Screenshots_151-181	MD_Screenshots 151-181.pdf	No	Fillable Fileable
Form and Instruction	6	MD_ScreenShots_1-50	MD_Scrren Shots 1-50.pdf	No	Fillable Fileable
Form and Instruction	8	MD_Screenshots_101-150	MD_Screenshot 101-150.pdf	No	Fillable Fileable
Form and Instruction	2	Massachusetts SNAP Application	Food Supplement Program-Paper Application MA_enclosure 2.pdf	No	Fillable Fileable
Form and Instruction	3	Maryland SNAP Application	Food Supplement Program-Paper Application MD_enclosure 2.pdf	No	Fillable Fileable
Form and Instruction	5	Virginia SNAP Application	Food Supplement Program-Paper Application VA_enclosure 2.pdf	No	Fillable Fileable
Form and Instruction	1	Indiana SNAP Application	Food Supplement Program-Paper Application Indiana_enclosure 2.pdf	No	Fillable Fileable
Form and Instruction	7	MD_Screenshot_51-100	MD_Screenshots 51-100.pdf	No	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

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
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	183	183
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Protocol	protocol enclosure 1.docx	09/24/2019
Demographic Quesitonnaire	demographic questionnaire enclosure 3.docx	09/24/2019
Mobile Device Use Questionnaire	Mobile devise use questionnaire_enclosure 4.docx	09/24/2019
Satisfaction Questionnaire	Satisfaction questionnaire_enclosure 5.docx	09/24/2019
Additional Screener Questions	additional screener question enclosure 6.docx	09/24/2019
Testing Plan	FNS - Usability Test Plan 8.19.19_enclosure 7.docx	09/24/2019
OMB Memo	omb letter_fns_v2.pdf	10/18/2019

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