Information Collection

DGA 2020-2025 Survey and Focus Group (English and Spanish)

IC 242953 under ICR 201902-0584-002 · OMB 0584-0523.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0523 can be found here:

2022-10-13 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A-1 Screener (English) clean OCIO 081120.docx www.notyetcreated.com	Other-Attachment A-1 Screener (Engli
Attachment A-2 Discussion Guide (English) clean OCIO 081120.docx www.notyetcreated.com	Other-Attachment A-2 Discussion Guid
Attachment A-3 Confirmation Form (English) clean OCIO 081120.docx Via email addresses	Other-Attachment A-3 Confirmation Fo
Attachment A-4 Consent Form (English).docx Via email addresses	Other-Attachment A-4 Consent Form (E
Attachment A-7 Focus Group Public Burden Statement (English).docx www.notyetcreated.com	Other-Attachment A-7 Focus Group Pub
Attachment A-7a Survey Public Burden Statement (English).docx www.notyetcreated.com	Other-Attachment A-7a Survey Public
Attachment A-8 Survey Questionnaire (English) clean OCIO 081020.docx www.notyetcreated.com	Other-Attachment A-8 Survey Question
Attachment A-9 Survey Invitation (English) clean OCIO 081120.docx www.notyetcreated.com	Other-Attachment A-9 Survey Invitati
Attachment A-10 Survey Screen Shots (English).pptx www.notyetcreated.com	Other-Attachment A-10 Survey Screen
Attachment C-1 Screener (English) clean OCIO 081020.docx www.notyetcreated.com	Other-Attachment C-1 Screener (Engli
Attachment C-2 Discussion Guide (English) clean OCIO 081120.docx www.notyetcreated.com	Other-Attachment C-2 Discussion Guid
Attachment E-1 Screener (English) clean OCIO 081120.docx www.notyetcreated.com	Other-Attachment E-1 Focus Group Scr
Attachment E-2 Discussion Guide (English) clean OCIO 081120 (v1).docx www.notyetcreated.com	Other- Attachment E-2 Discussion Gui
B-1 Screener (Spanish) clean OCIO 081120.docx www.notyetcreated.com	Other-Attachment B-1 Screener (Spani
B-2 Discussion Guide (Spanish) clean OCIO 081120.docx www.notyetcreated.com	Other-Attachment B-2 Discussion Guid
B-3 Confirmation Form (Spanish) clean OCIO 081120.docx Via email address	Other-Attachment B-3 Confirmation Fo
B-4 Consent Form (Spanish) clean OCIO 081120.docx via e-mail address	Other-Attachment B-4 Consent Form (S
B-7 Focus Group Public Burden Statement (Spanish).docx www.notyetcreated.com	Other-Attachment B-7 Focus Group Pub
B-7a Survey Public Burden Statement (Spanish).docx www.notyetcreated.com	Other-Attachment B-7a Survey Public
B-8 Survey Questionnaire (Spanish) clean OCIO 081020.docx www.notyetcreated.com	Other-Attachment B-8 Survey Question
B-9 Survey Invitation (Spanish) clean OCIO 081120.docx www.notyetcreated.com	Other-Attachment B-9 Survey Invitati
Attachment B-10 Survey Screen Shots (Spanish).pptx www.notyetcreated.com	Other-Attachment B-10 Survey Screen
D-1 Screener (Spanish) clean OCIO 081120.docx www.notyetcreated.com	Other-Attachment D-1 Screener (Spani
D-2 Discussion Guide (Spanish) clean OCIO 081120.docx www.notyetcreated.com	Other-Attachment D-2 Discussion Guid
Cover Memo_final clean OCIO 081020.docx DGC 2020-2025 OMB Memo	IC Document
Attachment E-3 Burden Estimates Excel Chart (English).xlsx Attachement 3 Burden Estimates Excel Chart	IC Document
Attachment A-5 Confidentiality Agreement (English).docx Attachment A-5 Confidentiality Agreement (English)	IC Document
B-5 Confidentiality Agreement (Spanish).docx Attachment B-5 Confidentiality Agreement (Spanish)	IC Document
Attachment A-6 Privacy Act Statement (English).docx Attachment A-6 Privacy Act Statement (English).docx	IC Document
B-6 Privacy Act Statement (Spanish).docx Attachment B-6 Privacy Act Statement (Spanish)	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

DGA 2020-2025 Survey and Focus Group (English and Spanish)

Agency IC Tracking Number:

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-Attachment C-1 Screener (English) (B-24 Caregiver Audience 8-11-2020)	Attachment C-1 Screener (English) clean OCIO 081020.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment C-2 Discussion Guide (English) (B-24 Caregiver Audience 8-11-2020)	Attachment C-2 Discussion Guide (English) clean OCIO 081120.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment A-1 Screener (English) (Pregnant Women 8-11-2020)	Attachment A-1 Screener (English) clean OCIO 081120.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment A-2 Discussion Guide (English) (Pregnant Women 8-11-2020)	Attachment A-2 Discussion Guide (English) clean OCIO 081120.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment A-3 Confirmation Form for Focus Group Participants (English 8-11-2020)	Attachment A-3 Confirmation Form (English) clean OCIO 081120.docx	Via email addresses	Yes	No	Fillable Fileable Signable
Other-Attachment A-4 Consent Form (English).docx	Attachment A-4 Consent Form (English).docx	Via email addresses	No		Fillable Fileable Signable
Other-Attachment A-7 Focus Group Public Burden Statement (English).docx	Attachment A-7 Focus Group Public Burden Statement (English).docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment A-7a Survey Public Burden Statement (English).docx	Attachment A-7a Survey Public Burden Statement (English).docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment A-8 Survey Questionnaire (English 8-10-2020).docx	Attachment A-8 Survey Questionnaire (English) clean OCIO 081020.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment A-9 Survey Invitation (English 8-11-2020)	Attachment A-9 Survey Invitation (English) clean OCIO 081120.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment A-10 Survey Screen Shots (English)	Attachment A-10 Survey Screen Shots (English).pptx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment E-1 Focus Group Screener (English) (Remaining Consumer Audiences 8-11-2020)	Attachment E-1 Screener (English) clean OCIO 081120.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other- Attachment E-2 Discussion Guide (English) (Remaining Consumer Audiences 8-11-2020)	Attachment E-2 Discussion Guide (English) clean OCIO 081120 (v1).docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment B-1 Screener (Spanish) (Pregnant Women)	B-1 Screener (Spanish) clean OCIO 081120.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment B-2 Discussion Guide (Spanish) (Pregnant Women)	B-2 Discussion Guide (Spanish) clean OCIO 081120.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment B-3 Confirmation Form for Focus Group Participants (Spanish)	B-3 Confirmation Form (Spanish) clean OCIO 081120.docx	Via email address	Yes	No	Fillable Fileable Signable
Other-Attachment B-4 Consent Form (Spanish)	B-4 Consent Form (Spanish) clean OCIO 081120.docx	via e-mail address	No		Fillable Fileable Signable
Other-Attachment B-7 Focus Group Public Burden Statement (Spanish)	B-7 Focus Group Public Burden Statement (Spanish).docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment B-7a Survey Public Burden Statement (Spanish)	B-7a Survey Public Burden Statement (Spanish).docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment B-8 Survey Questionnaire (Spanish)	B-8 Survey Questionnaire (Spanish) clean OCIO 081020.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment B-9 Survey Invitation (Spanish)	B-9 Survey Invitation (Spanish) clean OCIO 081120.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment B-10 Survey Screen Shots (Spanish)	Attachment B-10 Survey Screen Shots (Spanish).pptx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment D-1 Screener (Spanish) (B-24 Caregiver Audience)	D-1 Screener (Spanish) clean OCIO 081120.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment D-2 Discussion Guide (Spanish) (B-24 Caregiver Audience)	D-2 Discussion Guide (Spanish) clean OCIO 081120.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: USDA/FNS 8 FNS Studies and Reports

FR Citation: 56 FR 17251

Number of Respondents: 29,040

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	29,456	29,456
Annual IC Time Burden (Hours)	5,968	5,968
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DGC 2020-2025 OMB Memo	Cover Memo_final clean OCIO 081020.docx	08/10/2020
Attachement 3 Burden Estimates Excel Chart	Attachment E-3 Burden Estimates Excel Chart (English).xlsx	08/05/2020
Attachment A-5 Confidentiality Agreement (English)	Attachment A-5 Confidentiality Agreement (English).docx	08/07/2020
Attachment B-5 Confidentiality Agreement (Spanish)	B-5 Confidentiality Agreement (Spanish).docx	08/07/2020
Attachment A-6 Privacy Act Statement (English).docx	Attachment A-6 Privacy Act Statement (English).docx	08/11/2020
Attachment B-6 Privacy Act Statement (Spanish)	B-6 Privacy Act Statement (Spanish).docx	08/11/2020

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