Information Collection

Split Panel Test for Revised Survey Instrument--Respondents

IC 241357 under ICR 202004-0536-001 · OMB 0536-0043.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0536-0043 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A Test questionnaire CPS FSS.pdf	Other-Survey Instrument
Supplementary Supporting Statement for FSS Split Panel Test Part B.docx Supplementary Supporting Statement for FSS Split Panel Test Part B	IC Document
Attachment B Federal Register for FSS Split Panel Test.pdf Attachment B Federal Register for FSS Split Panel Test	IC Document
Attachment D Cognitive Testing Recommendations.pdf Attachment D Cognitive Testing Recommendations	IC Document
Supplementary Supporting Statement for FSS Split Panel Test Part A_rev.docx Supplementary Supporting Statement for FSS Split Panel Test Part A	IC Document

IC Title:

Split Panel Test for Revised Survey Instrument--Respondents

Agency IC Tracking Number:

Is this a Common Form? No

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Instrument			Attachment A Test questionnaire CPS FSS.pdf		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 31,200

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	31,200	31,200
Annual IC Time Burden (Hours)	4,599	4,599
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supplementary Supporting Statement for FSS Split Panel Test Part B	Supplementary Supporting Statement for FSS Split Panel Test Part B.docx	04/15/2020
Attachment B Federal Register for FSS Split Panel Test	Attachment B Federal Register for FSS Split Panel Test.pdf	04/15/2020
Attachment D Cognitive Testing Recommendations	Attachment D Cognitive Testing Recommendations.pdf	04/15/2020
Supplementary Supporting Statement for FSS Split Panel Test Part A	Supplementary Supporting Statement for FSS Split Panel Test Part A_rev.docx	04/16/2020

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