State, Local or Tribal Respondents

Appendix W. Site visit document request

OMB No. 0584-[NEW]

Survey of Supplemental Nutrition Assistance Program (SNAP) Employment and Training (E&T) Case Management

April 11, 2021

Project Officer: Kristen Corey

Office of Policy Support

Food and Nutrition Service

U.S. Department of Agriculture

1320 Braddock Place

Alexandria, VA 22314

Survey of SNAP E&T Case Management

Site visit document request

We request that the State send us documents related to case management, assessments, and participant reimbursements and other supports in advance of our site visit. We request the State send these documents via email to [insert site visit lead’s name and email address] within one month of our request, or sooner, if the site visit date is approaching. Examples of documents to send include:

• SNAP E&T procedures manuals

• Policy memos and written guidance related to case management, assessments, and participant reimbursements and other supports

• SNAP E&T brochures or pamphlets

• Examples of notices or letters sent to participants describing SNAP E&T, case management, assessments, or participant reimbursements and other supports

• Case manager training manuals and guidance

• Scripts used by eligibility workers, case managers, or other staff to explain assessments, participants reimbursements, and other supports

• Case manager job descriptions

• Sample contracts for case management services

• Non-proprietary assessment tools used with SNAP E&T participants

• Other case management tools, such as goal-setting sheets, individual development plan forms, and referral forms

• Financial reports that include information about participant reimbursements

• Other related State documents, such as relevant State legislation

• Formal communication with FNS regarding implementation of E&T case management, assessments, or participant reimbursements and other supports

Public Burden Statement

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 60 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.