Information Collection

Evaluation of FY 2019 Summer Electronic Benefit Transfer (EBT) Demonstrations - State and Tribal Grantees and SFAs (1 of 3))

IC 242284 under ICR 202105-0584-004 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B.1 Grantee Interview Protocol.docx	Other-Attachment B.1 Grantee Intervi
Attachment B.1 Grantee Interview Protocol.docx	Other-Attachment B.1 Grantee Intervi
Attachment D SFA Interview Protocol.docx	Other-Attachment D SFA Interview Pro
Attachment D SFA Interview Protocol.docx	Other-Attachment D SFA Interview Pro
Attachment C.1 Study Team Introductory Email to Grantees.docx Attachment C.1 Study Team Introductory Email to Grantees	IC Document
Attachment C.1 Study Team Introductory Email to Grantees.docx Attachment C.1 Study Team Introductory Email to Grantees	IC Document
Attachment C.2 Interview Confirmation Email Template for Grantees.docx Attachment C.2 Inteview Confirmation Email Template for Grantees	IC Document
Attachment C.2 Interview Confirmation Email Template for Grantees.docx Attachment C.2 Inteview Confirmation Email Template for Grantees	IC Document
Attachment E.1 Grantee Introductory Email to SFAs.docx Attachment E.1 Grantee Introductory Email to SFAs	IC Document
Attachment E.1 Grantee Introductory Email to SFAs.docx Attachment E.1 Grantee Introductory Email to SFAs	IC Document
Attachment E.2 Study Team Introductory Email to SFAs.docx Attachment E.2 Study Team Introductory Email to SFAs	IC Document
Attachment E.2 Study Team Introductory Email to SFAs.docx Attachment E.2 Study Team Introductory Email to SFAs	IC Document
Attachment E.3 Recruitment FAQ Sheet for SFAs.docx Attachment E.3 Recruitment FAQ Sheet for SFAs	IC Document
Attachment E.3 Recruitment FAQ Sheet for SFAs.docx Attachment E.3 Recruitment FAQ Sheet for SFAs	IC Document
Attachment E.4 Study Overview Sheet for SFAs.docx Attachment E.4 Study Overview Sheet for SFAs	IC Document
Attachment E.4 Study Overview Sheet for SFAs.docx Attachment E.4 Study Overview Sheet for SFAs	IC Document
Attachment E.5 Telephone Script for SFA Recruitment.docx Attachment E.5 Telephone Script for SFA Recruitment	IC Document
Attachment E.5 Telephone Script for SFA Recruitment.docx Attachment E.5 Telephone Script for SFA Recruitment	IC Document
Attachment E.6 Interview Confirmation Email Template for SFAs.docx Attachment E.6 Interview Confirmation Email Template for SFAs	IC Document
Attachment E.6 Interview Confirmation Email Template for SFAs.docx Attachment E.6 Interview Confirmation Email Template for SFAs	IC Document
Attachment A Burden table 6.17.20.xlsx Attachment A Burden Table	IC Document
Attachment A Burden table 6.17.20.xlsx Attachment A Burden Table	IC Document
Attachment J IRB Approval.pdf Attachment J IRB Approval	IC Document
Attachment J IRB Approval.pdf Attachment J IRB Approval	IC Document
2019 Summer EBT Generic Submission 25 Jun 2020 Memo.docx 2019 Summer EBT Generic Submission 25 Jun 2020 Memo	IC Document
2019 Summer EBT Generic Submission 25 Jun 2020 Memo.docx 2019 Summer EBT Generic Submission 25 Jun 2020 Memo	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Evaluation of FY 2019 Summer Electronic Benefit Transfer (EBT) Demonstrations - State and Tribal Grantees and SFAs (1 of 3))

Agency IC Tracking Number:

IC Status: Modified

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-Attachment B.1 Grantee Interview Protocol			Attachment B.1 Grantee Interview Protocol.docx		No		Paper Only
Other-Attachment D SFA Interview Protocol			Attachment D SFA Interview Protocol.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 FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 12

Number of Respondents for Small Entity: 5

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	72	72
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment C.1 Study Team Introductory Email to Grantees	Attachment C.1 Study Team Introductory Email to Grantees.docx	06/18/2020
Attachment C.2 Inteview Confirmation Email Template for Grantees	Attachment C.2 Interview Confirmation Email Template for Grantees.docx	06/18/2020
Attachment E.1 Grantee Introductory Email to SFAs	Attachment E.1 Grantee Introductory Email to SFAs.docx	06/18/2020
Attachment E.2 Study Team Introductory Email to SFAs	Attachment E.2 Study Team Introductory Email to SFAs.docx	06/18/2020
Attachment E.3 Recruitment FAQ Sheet for SFAs	Attachment E.3 Recruitment FAQ Sheet for SFAs.docx	06/18/2020
Attachment E.4 Study Overview Sheet for SFAs	Attachment E.4 Study Overview Sheet for SFAs.docx	06/18/2020
Attachment E.5 Telephone Script for SFA Recruitment	Attachment E.5 Telephone Script for SFA Recruitment.docx	06/18/2020
Attachment E.6 Interview Confirmation Email Template for SFAs	Attachment E.6 Interview Confirmation Email Template for SFAs.docx	06/18/2020
Attachment A Burden Table	Attachment A Burden table 6.17.20.xlsx	06/18/2020
Attachment J IRB Approval	Attachment J IRB Approval.pdf	06/18/2020
2019 Summer EBT Generic Submission 25 Jun 2020 Memo	2019 Summer EBT Generic Submission 25 Jun 2020 Memo.docx	06/26/2020

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