Information Collection

Individuals/Households Respondents (including ages 60-69)

IC 241929 under ICR 202005-0584-004 · OMB 0584-0664.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Appendix O-1 Survey of SNAP and Work English Web.docx Other-Appendix O-1 Survey of SNAP an
Appendix O-1 Survey of SNAP and Work English Web_5_11_21clean.docx Other-Appendix O-1 Survey of SNAP an
Appendix O-2 Survey of SNAP and Work Spanish Web.docx Other-Appendix O-2 Survey of SNAP an
Appendix O-2 Survey of SNAP and Work Spanish Web_5-18-21clean.docx Other-Appendix O-2 Survey of SNAP an
Appendix O-3 Screen Shots Survey of SNAP and Work English Web.docx Other-Appendix O-3 Screen Shots Surv
Appendix O-3 Screen Shots -- Survey of SNAP and Work English Web_5_20_21.docx Other-Appendix O-3 Screen Shots Surv
Appendix O-4 Screen Shots Survey of SNAP and Work Spanish Web.docx Other-Appendix O-4 Screen Shots Surv
Appendix O-4 Screen Shots -- Survey of SNAP and Work Spanish Web_5_20_21.docx Other-Appendix O-4 Screen Shots Surv
Appendix O-5 Survey of SNAP and Work English CATI.docx Other-Appendix O-5 Survey of SNAP an
Appendix O-5 Survey of SNAP and Work English CATI_5_18_21clean.docx Other-Appendix O-5 Survey of SNAP an
Appendix O-6 Survey of SNAP and Work Spanish CATI.docx Other-Appendix O-6 Survey of SNAP an
Appendix O-6 Survey of SNAP and Work Spanish CATI_5_18_21clean.docx Other-Appendix O-6 Survey of SNAP an
Appendix P-1 Telephone follow-up script English.docx Other-Appendix P-1 Telephone follow-
Appendix P-1 Telephone follow-up script English_2_17_21clean.docx Other-Appendix P-1 Telephone follow-
Appendix P-2 Telephone follow-up script Spanish.docx Other-Appendix P-2 Telephone follow-
Appendix P-2 Telephone follow-up script Spanish_4_14_21clean.docx Other-Appendix P-2 Telephone follow-
Appendix Q-1 Guidelines for in-person field recruitment English.docx Other-Appendix Q-1 Guidelines for in
Appendix Q-1 Guidelines for in-person field recruitment English.docx Other-Appendix Q-1 Guidelines for in
Appendix Q-2 Guidelines for in-person field recruitment Spanish.docx Other-Appendix Q-2 Guidelines for in
Appendix Q-2 Guidelines for in-person field recruitment Spanish.docx Other-Appendix Q-2 Guidelines for in
Appendix H-1 Survey invitation letter English.docx
Appendix H-1 Survey invitation letter English.docx
IC Document
Appendix H-1 Survey invitation letter English_2_17_21clean.docx
Appendix H-1 Survey invitation letter English.docx
IC Document
Appendix H-2 Survey invitation letter Spanish.docx
Appendix H-2 Survey invitation letter Spanish.docx
IC Document
Appendix H-2 Survey invitation letter Spanish_4_13_21clean.docx
Appendix H-2 Survey invitation letter Spanish.docx
IC Document
Appendix I-1 Study brochure English.pdf
Appendix I-1 Study brochure English.pdf
IC Document
Appendix I-1 Study brochure English_4_14_21.pdf
Appendix I-1 Study brochure English.pdf
IC Document
Appendix I-2 Study brochure Spanish.pdf
Appendix I-2 Study brochure Spanish
IC Document
Appendix I-2 Study brochure Spanish_4_14_21.pdf
Appendix I-2 Study brochure Spanish
IC Document
Appendix J-1 Survey reminder postcard English.docx
Appendix J-1 Survey reminder postcard English
IC Document
Appendix J-1 Survey reminder postcard English_2_17_21clean.docx
Appendix J-1 Survey reminder postcard English
IC Document
Appendix J-2 Survey reminder postcard Spanish.docx
Appendix J-2 Survey reminder postcard Spanish
IC Document
Appendix J-2 Survey reminder postcard Spanish_4_13_21clean.docx
Appendix J-2 Survey reminder postcard Spanish
IC Document
Appendix K-1 Field locating letter English.docx
Appendix K-1 Field locating letter English
IC Document
Appendix K-1 Field locating letter English.docx
Appendix K-1 Field locating letter English
IC Document
Appendix K-2 Field locating letter Spanish.docx
Appendix K-2 Field locating letter Spanish
IC Document
Appendix K-2 Field locating letter Spanish.docx
Appendix K-2 Field locating letter Spanish
IC Document
Appendix L-1 Sorry I missed you card English.docx
Appendix K-2 Field locating letter Spanish.docx
IC Document
Appendix L-1 Sorry I missed you card English.docx
Appendix K-2 Field locating letter Spanish.docx
IC Document
Appendix L-2 Sorry I missed you card Spanish.docx
Appendix L-2 Sorry I missed you card Spanish
IC Document
Appendix L-2 Sorry I missed you card Spanish.docx
Appendix L-2 Sorry I missed you card Spanish
IC Document
Appendix M-1 Thank you letter early response English.docx
Appendix M-1 Thank you letter early response English
IC Document
Appendix M-1 Thank you letter early response English.docx
Appendix M-1 Thank you letter early response English
IC Document
Appendix M-2 Thank you letter early response Spanish.docx
Appendix M-2 Thank you letter early response Spanish
IC Document
Appendix M-2 Thank you letter early response Spanish.docx
Appendix M-2 Thank you letter early response Spanish
IC Document
Appendix M-3 Thank you letter English.docx
Appendix M-3 Thank you letter English
IC Document
Appendix M-3 Thank you letter English_2_17_21clean.docx
Appendix M-3 Thank you letter English
IC Document
Appendix M-4 Thank you letter Spanish.docx
Appendix M-4 Thank you letter Spanish.docx
IC Document
Appendix M-4 Thank you letter Spanish_4_13_21clean.docx
Appendix M-4 Thank you letter Spanish.docx
IC Document
Appendix H-3 Survey invitation letter English_elderly 4_13_21.docx
Appendix H-3 Survey invitation letter English elderly 4_13_21
IC Document
Appendix H-4 Survey invitation letter Spanish_elderly 4_13_21.docx
Appendix H-4 Survey invitation letter Spanish elderly 4_13_21
IC Document
Appendix J-3 Survey reminder letter English_4_13_2.docx
Appendix J-3 Survey reminder letter English_4_13_2
IC Document
Appendix J-4 Survey reminder letter Spanish_4_13_21.docx
Appendix J-4 Survey reminder letter Spanish_4_13_21
IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-Appendix O-1 Survey of SNAP and Work English Web https://www.website forthcoming.com Yes Yes Fillable Fileable Signable
Other-Appendix O-2 Survey of SNAP and Work Spanish Web.docx https://www.website forthcoming.com Yes Yes Fillable Fileable Signable
Other-Appendix O-3 Screen Shots Survey of SNAP and Work English Web https://www.website forthcoming.com Yes Yes Fillable Fileable Signable
Other-Appendix O-4 Screen Shots Survey of SNAP and Work Spanish Web https://www.website forthcoming.com Yes Yes Fillable Fileable Signable
Other-Appendix O-5 Survey of SNAP and Work English CATI https://www.website forthcoming.com Yes Yes Fillable Fileable Signable
Other-Appendix O-6 Survey of SNAP and Work Spanish CATI https://www.website forthcoming.com Yes Yes Fillable Fileable Signable
Other-Appendix P-1 Telephone follow-up script English https://www.website forthcoming.com Yes Yes Fillable Fileable Signable
Other-Appendix P-2 Telephone follow-up script Spanish https://www.website forthcoming.com Yes Yes Fillable Fileable Signable
Other-Appendix Q-1 Guidelines for in-person field recruitment English.docx https://www.website forthcoming.com Yes Yes Fillable Fileable Signable
Other-Appendix Q-2 Guidelines for in-person field recruitment Spanish https://www.website forthcoming.com Yes Yes Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 316,695 0 316,695 0 0 0
Annual IC Time Burden (Hours) 30,111 0 30,111 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Appendix H-1 Survey invitation letter English.docx 05/27/2021
Appendix H-2 Survey invitation letter Spanish.docx 05/27/2021
Appendix I-1 Study brochure English.pdf 05/27/2021
Appendix I-2 Study brochure Spanish 05/27/2021
Appendix J-1 Survey reminder postcard English 05/27/2021
Appendix J-2 Survey reminder postcard Spanish 05/27/2021
Appendix K-1 Field locating letter English 10/01/2020
Appendix K-2 Field locating letter Spanish 10/01/2020
Appendix K-2 Field locating letter Spanish.docx 10/01/2020
Appendix L-2 Sorry I missed you card Spanish 10/01/2020
Appendix M-1 Thank you letter early response English 10/01/2020
Appendix M-2 Thank you letter early response Spanish 10/01/2020
Appendix M-3 Thank you letter English 05/27/2021
Appendix M-4 Thank you letter Spanish.docx 05/27/2021
Appendix H-3 Survey invitation letter English elderly 4_13_21 05/27/2021
Appendix H-4 Survey invitation letter Spanish elderly 4_13_21 05/27/2021
Appendix J-3 Survey reminder letter English_4_13_2 05/27/2021
Appendix J-4 Survey reminder letter Spanish_4_13_21 05/27/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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