Information Collection

Individuals and Households Respondents

IC 247754 under ICR 202105-0584-001 · OMB 0584-0669.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0669 can be found here:

2022-10-17 - No material or nonsubstantive change to a currently approved collection
2022-05-02 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
G3_Parent Brochure.pdf	Other-G3_Parent Brochure
G3_Parent Brochure.pdf	Other-G3_Parent Brochure
G7_Description of Study for Provider Newsletter.docx	Other-G7_Description of Study for Pr
G7_Description of Study for Provider Newsletter.docx	Other-G7_Description of Study for Pr
G8_Description of Study for Provider Newsletter - Spanish.docx	Other-G8_Description of Study for Pr
G8_Description of Study for Provider Newsletter - Spanish.docx	Other-G8_Description of Study for Pr
G15_Parent Consent and Permission Form (Children).docx	Other-G15_Parent Consent and Permiss
G15_Parent Consent and Permission Form (Children).docx	Other-G15_Parent Consent and Permiss
G16_Parent Consent and Permission Form (Children) - Spanish.docx	Other-G16_Parent Consent and Permiss
G16_Parent Consent and Permission Form (Children) - Spanish.docx	Other-G16_Parent Consent and Permiss
G17_Parent Consent Talking Points (Children).docx	Other-G17_Parent Consent Talking Poi
G17_Parent Consent Talking Points (Children).docx	Other-G17_Parent Consent Talking Poi
G18_Parent Consent Talking Points (Children) - Spanish.docx	Other-G18_Parent Consent Talking Poi
G18_Parent Consent Talking Points (Children) - Spanish.docx	Other-G18_Parent Consent Talking Poi
G19_Parent Confirmation of Enrollment (Children).docx	Other-G19_Parent Confirmation of Enr
G19_Parent Confirmation of Enrollment (Children).docx	Other-G19_Parent Confirmation of Enr
G20_Parent Confirmation of Enrollment (Children) - Spanish.docx	Other-G20_Parent Confirmation of Enr
G20_Parent Confirmation of Enrollment (Children) - Spanish.docx	Other-G20_Parent Confirmation of Enr
H1_Reminder for Parent Interview.docx	Other-H1_Reminder for Parent Intervi
H1_Reminder for Parent Interview.docx	Other-H1_Reminder for Parent Intervi
H2_Reminder for Parent Interview - Spanish.docx	Other-H2_Reminder for Parent Intervi
H2_Reminder for Parent Interview - Spanish.docx	Other-H2_Reminder for Parent Intervi
H3_Parent Interview for In-Care Day.docx	Other-H3_Parent Interview for In-Car
H3_Parent Interview for In-Care Day.docx	Other-H3_Parent Interview for In-Car
H4_Parent Interview for In-Care Day - Spanish.docx	Other-H4_Parent Interview for In-Car
H4_Parent Interview for In-Care Day - Spanish.docx	Other-H4_Parent Interview for In-Car
H5_Child Food Diary Cover Letter.docx	Other-H5_Child Food Diary Cover Lett
H5_Child Food Diary Cover Letter.docx	Other-H5_Child Food Diary Cover Lett
H6_Child Food Diary Cover Letter - Spanish.docx	Other-H6_Child Food Diary Cover Lett
H6_Child Food Diary Cover Letter - Spanish.docx	Other-H6_Child Food Diary Cover Lett
H7_Child Food Diary.docx	Other-H7_Child Food Diary
H8_Child Food Diary - Spanish.docx	Other-H8_Child Food Diary - Spanish
H11_Parent Interview for ASA24 Only.docx	Other-H11_Parent Interview for ASA24
H11_Parent Interview for ASA24 Only.docx	Other-H11_Parent Interview for ASA24
H12_Parent Interview for ASA24 Only - Spanish.docx	Other-H12_Parent Interview for ASA24
H12_Parent Interview for ASA24 Only - Spanish.docx	Other-H12_Parent Interview for ASA24
D1_Recruitment Website_6.11.21.pdf	Other-D1_Recruitment Website
D1_Recruitment Website_6.11.21.pdf	Other-D1_Recruitment Website
D2_Recruitment Website - Spanish_6.11.21.pdf	Other-D2_Recruitment Website - Spani
D2_Recruitment Website - Spanish_6.11.21.pdf	Other-D2_Recruitment Website - Spani
G1_Parent Recruitment Letter (Infants).docx	Other-G1_Parent Recruitment Letter (
G1_Parent Recruitment Letter (Infants).docx	Other-G1_Parent Recruitment Letter (
G2_Parent Recruitment Letter (Infants) - Spanish.docx	Other-G2_Parent Recruitment Letter (
G2_Parent Recruitment Letter (Infants) - Spanish.docx	Other-G2_Parent Recruitment Letter (
G4_Parent Brochure - Spanish.pdf	Other-G4_Parent Brochure - Spanish
G4_Parent Brochure - Spanish.pdf	Other-G4_Parent Brochure - Spanish
G23_Parent Consent and Permission Form (Youth).docx	Other-G23_Parent Consent and Permiss
G23_Parent Consent and Permission Form (Youth).docx	Other-G23_Parent Consent and Permiss
G24_Parent Consent and Permission Form (Youth) - Spanish.docx	Other-G24_Parent Consent and Permiss
G24_Parent Consent and Permission Form (Youth) - Spanish.docx	Other-G24_Parent Consent and Permiss
G25_Parent Consent Talking Points (Youth).docx	Other-G25_Parent Consent Talking Poi
G25_Parent Consent Talking Points (Youth).docx	Other-G25_Parent Consent Talking Poi
G26_Parent Consent Talking Points (Youth) - Spanish.docx	Other-G26_Parent Consent Talking Poi
G26_Parent Consent Talking Points (Youth) - Spanish.docx	Other-G26_Parent Consent Talking Poi
G27_Parent Confirmation of Enrollment (Youth).docx	Other-G27_Parent Confirmation of Enr
G27_Parent Confirmation of Enrollment (Youth).docx	Other-G27_Parent Confirmation of Enr
G28_Parent Confirmation of Enrollment (Youth) - Spanish.docx	Other-G28_Parent Confirmation of Enr
G28_Parent Confirmation of Enrollment (Youth) - Spanish.docx	Other-G28_Parent Confirmation of Enr
H13_Parent Interview for Teen Sample.docx	Other-H13_Parent Interview for Teen
H13_Parent Interview for Teen Sample.docx	Other-H13_Parent Interview for Teen
H14_Parent Interview for Teen Sample - Spanish.docx	Other-H14_Parent Interview for Teen
H14_Parent Interview for Teen Sample - Spanish.docx	Other-H14_Parent Interview for Teen
G5_Parent Consent and Permission Form (Infants).docx	Other-G5_Parent Consent and Permissi
G5_Parent Consent and Permission Form (Infants).docx	Other-G5_Parent Consent and Permissi
G6_Parent Consent and Permission Form (Infants) - Spanish.docx	Other-G6_Parent Consent and Permissi
G6_Parent Consent and Permission Form (Infants) - Spanish.docx	Other-G6_Parent Consent and Permissi
G7_Description of Study for Provider Newsletter.docx	Other-G7_Description of Study for Pr
G7_Description of Study for Provider Newsletter.docx	Other-G7_Description of Study for Pr
G8_Description of Study for Provider Newsletter - Spanish.docx	Other-G8_Description of Study for Pr
G8_Description of Study for Provider Newsletter - Spanish.docx	Other-G8_Description of Study for Pr
G9_Parent Consent Talking Points (Infants).docx	Other-G9_Parent Consent Talking Poin
G9_Parent Consent Talking Points (Infants).docx	Other-G9_Parent Consent Talking Poin
G10_Parent Consent Talking Points (Infants) - Spanish.docx	Other-G10_Parent Consent Talking Poi
G10_Parent Consent Talking Points (Infants) - Spanish.docx	Other-G10_Parent Consent Talking Poi
G11_Parent Confirmation of Enrollment (Infants).docx	Other-G11_Parent Confirmation of Enr
G11_Parent Confirmation of Enrollment (Infants).docx	Other-G11_Parent Confirmation of Enr
G12_Parent Confirmation of Enrollment (Infants) - Spanish.docx	Other-G12_Parent Confirmation of Enr
G12_Parent Confirmation of Enrollment (Infants) - Spanish.docx	Other-G12_Parent Confirmation of Enr
H15_Child Height and Weight Form.docx	Other-H15_Child Height and Weight Fo
H15_Child Height and Weight Form.docx	Other-H15_Child Height and Weight Fo
F21_Food and Physical Activity Experiences Survey.docx	Other-F21_Food and Physical Activity
F21_Food and Physical Activity Experiences Survey.docx	Other-F21_Food and Physical Activity
F22_Food and Physical Activity Experiences Survey - Spanish.docx	Other-F22_Food and Physical Activity
F22_Food and Physical Activity Experiences Survey - Spanish.docx	Other-F22_Food and Physical Activity
G13_Parent Recruitment Letter (Children).docx	Other-G13_Parent Recruitment Letter
G13_Parent Recruitment Letter (Children).docx	Other-G13_Parent Recruitment Letter
G14_Parent Recruitment Letter (Children) - Spanish.docx	Other-G14_Parent Recruitment Letter
G14_Parent Recruitment Letter (Children) - Spanish.docx	Other-G14_Parent Recruitment Letter
G21_Parent Recruitment Letter (Youth).docx	Other-G21_Parent Recruitment Letter
G21_Parent Recruitment Letter (Youth).docx	Other-G21_Parent Recruitment Letter
G22_Parent Recruitment Letter (Youth) - Spanish.docx	Other-G22_Parent Recruitment Letter
G22_Parent Recruitment Letter (Youth) - Spanish.docx	Other-G22_Parent Recruitment Letter
H7_Child Food Diary_revised 2021.10.08_clean.docx	Other-H7_Child Food Diary_revised 20
H8_Child Food Diary_Spanish_revised 2021.10.08_clean.docx	Other-H8_Child Food Diary_Spanish_re
H9_Food Model Booklet_7.20.21.pdf H9_Food Model Booklet	IC Document
H9_Food Model Booklet_7.20.21.pdf H9_Food Model Booklet	IC Document
H10_Food Model Booklet-Spanish_7.20.21.pdf H10_Food Model Booklet-Spanish	IC Document
H10_Food Model Booklet-Spanish_7.20.21.pdf H10_Food Model Booklet-Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Individuals and Households 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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-G3_Parent Brochure	G3_Parent Brochure.pdf	No		Paper Only
Other-G7_Description of Study for Provider Newsletter	G7_Description of Study for Provider Newsletter.docx	No		Paper Only
Other-G8_Description of Study for Provider Newsletter - Spanish	G8_Description of Study for Provider Newsletter - Spanish.docx	No		Paper Only
Other-G15_Parent Consent and Permission Form (Children)	G15_Parent Consent and Permission Form (Children).docx	No		Paper Only
Other-G16_Parent Consent and Permission Form (Children) - Spanish	G16_Parent Consent and Permission Form (Children) - Spanish.docx	No		Paper Only
Other-G17_Parent Consent Talking Points (Children)	G17_Parent Consent Talking Points (Children).docx	No		Paper Only
Other-G18_Parent Consent Talking Points (Children) - Spanish	G18_Parent Consent Talking Points (Children) - Spanish.docx	No		Paper Only
Other-G19_Parent Confirmation of Enrollment (Children)	G19_Parent Confirmation of Enrollment (Children).docx	No		Paper Only
Other-G20_Parent Confirmation of Enrollment (Children) - Spanish	G20_Parent Confirmation of Enrollment (Children) - Spanish.docx	No		Paper Only
Other-H1_Reminder for Parent Interview	H1_Reminder for Parent Interview.docx	Yes	No	Printable Only
Other-H2_Reminder for Parent Interview - Spanish	H2_Reminder for Parent Interview - Spanish.docx	Yes	No	Printable Only
Other-H3_Parent Interview for In-Care Day	H3_Parent Interview for In-Care Day.docx	No		Paper Only
Other-H4_Parent Interview for In-Care Day - Spanish	H4_Parent Interview for In-Care Day - Spanish.docx	No		Paper Only
Other-H5_Child Food Diary Cover Letter	H5_Child Food Diary Cover Letter.docx	No		Paper Only
Other-H6_Child Food Diary Cover Letter - Spanish	H6_Child Food Diary Cover Letter - Spanish.docx	No		Paper Only
Other-H11_Parent Interview for ASA24 Only	H11_Parent Interview for ASA24 Only.docx	No		Paper Only
Other-H12_Parent Interview for ASA24 Only - Spanish	H12_Parent Interview for ASA24 Only - Spanish.docx	No		Paper Only
Other-D1_Recruitment Website	D1_Recruitment Website_6.11.21.pdf	Yes	Yes	Fillable Printable
Other-D2_Recruitment Website - Spanish	D2_Recruitment Website - Spanish_6.11.21.pdf	Yes	Yes	Fillable Printable
Other-G1_Parent Recruitment Letter (Infants)	G1_Parent Recruitment Letter (Infants).docx	No		Paper Only
Other-G2_Parent Recruitment Letter (Infants) - Spanish	G2_Parent Recruitment Letter (Infants) - Spanish.docx	No		Paper Only
Other-G4_Parent Brochure - Spanish	G4_Parent Brochure - Spanish.pdf	No		Paper Only
Other-G23_Parent Consent and Permission Form (Youth)	G23_Parent Consent and Permission Form (Youth).docx	No		Paper Only
Other-G24_Parent Consent and Permission Form (Youth) - Spanish	G24_Parent Consent and Permission Form (Youth) - Spanish.docx	No		Paper Only
Other-G25_Parent Consent Talking Points (Youth)	G25_Parent Consent Talking Points (Youth).docx	No		Paper Only
Other-G26_Parent Consent Talking Points (Youth) - Spanish	G26_Parent Consent Talking Points (Youth) - Spanish.docx	No		Paper Only
Other-G27_Parent Confirmation of Enrollment (Youth)	G27_Parent Confirmation of Enrollment (Youth).docx	No		Paper Only
Other-G28_Parent Confirmation of Enrollment (Youth) - Spanish	G28_Parent Confirmation of Enrollment (Youth) - Spanish.docx	No		Paper Only
Other-H13_Parent Interview for Teen Sample	H13_Parent Interview for Teen Sample.docx	No		Paper Only
Other-H14_Parent Interview for Teen Sample - Spanish	H14_Parent Interview for Teen Sample - Spanish.docx	No		Paper Only
Other-G5_Parent Consent and Permission Form (Infants)	G5_Parent Consent and Permission Form (Infants).docx	No		Paper Only
Other-G6_Parent Consent and Permission Form (Infants) - Spanish	G6_Parent Consent and Permission Form (Infants) - Spanish.docx	No		Paper Only
Other-G7_Description of Study for Provider Newsletter	G7_Description of Study for Provider Newsletter.docx	No		Paper Only
Other-G8_Description of Study for Provider Newsletter - Spanish	G8_Description of Study for Provider Newsletter - Spanish.docx	No		Paper Only
Other-G9_Parent Consent Talking Points (Infants)	G9_Parent Consent Talking Points (Infants).docx	No		Paper Only
Other-G10_Parent Consent Talking Points (Infants) - Spanish	G10_Parent Consent Talking Points (Infants) - Spanish.docx	No		Paper Only
Other-G11_Parent Confirmation of Enrollment (Infants)	G11_Parent Confirmation of Enrollment (Infants).docx	No		Paper Only
Other-G12_Parent Confirmation of Enrollment (Infants) - Spanish	G12_Parent Confirmation of Enrollment (Infants) - Spanish.docx	No		Paper Only
Other-H15_Child Height and Weight Form	H15_Child Height and Weight Form.docx	No		Paper Only
Other-F21_Food and Physical Activity Experiences Survey	F21_Food and Physical Activity Experiences Survey.docx	No		Paper Only
Other-F22_Food and Physical Activity Experiences Survey - Spanish	F22_Food and Physical Activity Experiences Survey - Spanish.docx	No		Paper Only
Other-G13_Parent Recruitment Letter (Children)	G13_Parent Recruitment Letter (Children).docx	No		Printable Only
Other-G14_Parent Recruitment Letter (Children) - Spanish	G14_Parent Recruitment Letter (Children) - Spanish.docx	No		Printable Only
Other-G21_Parent Recruitment Letter (Youth)	G21_Parent Recruitment Letter (Youth).docx	No		Paper Only
Other-G22_Parent Recruitment Letter (Youth) - Spanish	G22_Parent Recruitment Letter (Youth) - Spanish.docx	No		Paper Only
Other-H7_Child Food Diary_revised 2021.10.08_clean	H7_Child Food Diary_revised 2021.10.08_clean.docx	No		Paper Only
Other-H8_Child Food Diary_Spanish_revised 2021.10.08_clean	H8_Child Food Diary_Spanish_revised 2021.10.08_clean.docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-8 USDA/FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 8,441

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 19 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16,681	16,681
Annual IC Time Burden (Hours)	9,359	9,359
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
H9_Food Model Booklet	H9_Food Model Booklet_7.20.21.pdf	07/20/2021
H10_Food Model Booklet-Spanish	H10_Food Model Booklet-Spanish_7.20.21.pdf	07/20/2021

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