Individuals/Households SNAP Participants Respondents

Attachment P. Client Consent Form for Observations

OMB No. 0584-[NEW]

Job Search as a Supplemental Nutrition Assistance Program (SNAP) Employment and Training (E&T) Component

January 14, 2021

Project Officer: Danielle Deemer

Office of Policy Support

Food and Nutrition Service

U.S. Department of Agriculture

1320 Braddock Place

Alexandria, VA 22314

703.305.2952

[email protected]

Job Search as a SNAP E&T Component:
Client Observation Consent Form

1. Introduction/ Verbal Consent for Observations

Hello, my name is [NAME], and I am here to observe how the SNAP office informs clients like you of the SNAP Employment and Training, or E&T, program.

I am here on behalf of the U.S. Department of Agriculture, the agency that runs the Supplemental Nutrition Assistance Program (SNAP).

The U.S. Department of Agriculture Food and Nutrition Service is doing a study to understand the overall role of job search activities in serving SNAP E&T participants and how well these activities work in helping people find a job.

I’ve asked the staff here if it would be okay for me to observe their interactions with clients regarding referrals to E&T and any other discussion of E&T program aspects. Would be ok if I sat in and watched? Of course, you are free to say no and there will be no penalties assessed or benefits withheld if you chose not to participate in part or as a whole.

The reason I want to observe is just so I can see how the E&T process works here.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-xxxx. The time required to complete this information collection is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the following address: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 1320 Braddock Place, Alexandria, VA 22314, ATTN: PRA (0584-xxxx). Do not return the completed form to this address.

[OBTAIN VERBAL CONSENT]

[Note to observer: If client says yes, proceed with the observation as described in Attachment H: Observation Checklist. If client says no, do not continue the observation and leave the observation site.]