Information Collection

Evaluation of FY 2019 Summer Electronic Benefit Transfer (EBT) Demonstrations - Parents/Caregivers of Children (2 of 3)

IC 242285 under ICR 201906-0584-001 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment F.1 Focus Group Sign-in Sheet.docx	Other-Attachment F.1 Focus Group Sig
Attachment F.2 Focus Group Consent Form.docx	Other-Attachment F.2 Focus Group Con
Attachment F.3 ParentCaregiver Focus Group Interview Protocol_25 Jun 2020.docx	Other-Attachment F.3 Parent/Caregive
Attachment A Burden table 6.17.20.xlsx Attachment A Burden Table	IC Document
Attachment J IRB Approval.pdf Attachment J IRB Approval	IC Document
Attachment G.1 Recruitment FlyerHandout for Focus Group_25 Jun 2020.docx Attachment G.1 Recruitment Flyer/Handout for Focus Group	IC Document
Attachment G.2 Recruitment FAQ Sheet for Focus Groups_25 Jun 2020.docx Attachment G.2 Recruitment FAQ Sheet for Focus Groups	IC Document
Attachment G.3 Study Overview Sheet for Focus Group Participants_25 Jun ....docx Attachment G.3 Study Overview Sheet for Focus Group Participants	IC Document
Attachment G.4 Telephone Script for Focus Group Confirmation_25 Jun 2020.docx Attachment G.4 Telephone Script for Focus Group Confirmation	IC Document
Attachment G.5 Focus Group Confirmation Email Template for Focus Group_25 Jun 2020.docx Attachment G.5 Focus Group Confirmation Email Template for Focus Group Participants	IC Document
2019 Summer EBT Generic Submission 25 Jun 2020 Memo.docx 2019 Summer EBT Generic Submission 25 Jun 2020 Memo	IC Document

IC Title:

Evaluation of FY 2019 Summer Electronic Benefit Transfer (EBT) Demonstrations - Parents/Caregivers of Children (2 of 3)

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	Available Electronically?	Electronic Capability
Other-Attachment F.1 Focus Group Sign-In Sheet	Attachment F.1 Focus Group Sign-in Sheet.docx	No	Paper Only
Other-Attachment F.2 Focus Group Consent Form	Attachment F.2 Focus Group Consent Form.docx	No	Paper Only
Other-Attachment F.3 Parent/Caregiver Focus Group Interview Protocol	Attachment F.3 ParentCaregiver Focus Group Interview Protocol_25 Jun 2020.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-8 FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 480

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	1,680	1,680
Annual IC Time Burden (Hours)	166	166
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A Burden Table	Attachment A Burden table 6.17.20.xlsx	06/18/2020
Attachment J IRB Approval	Attachment J IRB Approval.pdf	06/18/2020
Attachment G.1 Recruitment Flyer/Handout for Focus Group	Attachment G.1 Recruitment FlyerHandout for Focus Group_25 Jun 2020.docx	06/26/2020
Attachment G.2 Recruitment FAQ Sheet for Focus Groups	Attachment G.2 Recruitment FAQ Sheet for Focus Groups_25 Jun 2020.docx	06/26/2020
Attachment G.3 Study Overview Sheet for Focus Group Participants	Attachment G.3 Study Overview Sheet for Focus Group Participants_25 Jun ....docx	06/26/2020
Attachment G.4 Telephone Script for Focus Group Confirmation	Attachment G.4 Telephone Script for Focus Group Confirmation_25 Jun 2020.docx	06/26/2020
Attachment G.5 Focus Group Confirmation Email Template for Focus Group Participants	Attachment G.5 Focus Group Confirmation Email Template for Focus Group_25 Jun 2020.docx	06/26/2020
2019 Summer EBT Generic Submission 25 Jun 2020 Memo	2019 Summer EBT Generic Submission 25 Jun 2020 Memo.docx	06/26/2020

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