Information Collection

Individuals/Households - Households

IC 226896 under ICR 202106-0584-003 · OMB 0584-0530.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0530 can be found here:

2022-08-23 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
B5a. (Instrument E1) Household Survey_v12_English.docx	Other-B5a. (Instrument E1) Household
B5b. (Instrument E1) Household Survey_Spanish.docx	Other-B5b. (Instrument E1) Household
B6a. (Instrument E7) Household Survey Income Worksheet_v4_English.docx	Other-B6a. (Instrument E7) Household
B6b. (Instrument E7) Household Income Worksheet_Spanish.docx	Other-B6b. (Instrument E7) Household
B7a. (Instrument E10) Instructions for Inc Documentation After Survey_v6_English.docx	Other-B7a. (Instrument E10) Instruct
B7b. (Instrument E10) Instructions for Inc Documentation_Spanish.docx	Other-B7b. (Instrument E10) Instruct
C16a. (Recruitment 018) Household Survey Brochure v3_English.pdf C16a. (Recruitment 018) Household Survey Brochure v3_English	IC Document
C16b. (Recruitment 018) Household Survey Brochure_Spanish.pdf C16b. (Recruitment 018) Household Survey Brochure_Spanish	IC Document
C22a. (Recruitment 017) Household Survey Recruitment Letter_v6_English.docx C22a. (Recruitment 017) Household Survey Recruitment Letter_v6_English	IC Document
C22b. (Recruitment 017) Household Survey Recruitment Letter_SPANISH.docx C22b. (Recruitment 017) Household Survey Recruitment Letter_SPANISH	IC Document
C23a. (Recruitment 019) Household Survey Recruitment Guide-Virtual Survey_v7_English.docx C23a. (Recruitment 019) Household Survey Recruitment Guide-Virtual Survey_v7_English	IC Document
C23b. (Recruitment 019). Household Survey Recruitment Guide-Virtual_SPANISH.docx C23b. (Recruitment 019). Household Survey Recruitment Guide-Virtual_SPANISH	IC Document
C24a. (Recruitment 020) Household Confirmation and Reminder of Virtual Survey_v6_English.docx C24a. (Recruitment 020) Household Confirmation and Reminder of Virtual Survey_v6_English	IC Document
C24b. (Recruitment 020). Household Confirmation and Reminder of Virtual Survey_Spanish.docx C24b. (Recruitment 020). Household Confirmation and Reminder of Virtual Survey_Spanish	IC Document
C25a. (Recruitment 025) Household Consent form_Virtual Survey_v3_English.docx C25a. (Recruitment 025) Household Consent form_Virtual Survey_v3_English	IC Document
C25b. (Recruitment 025) Household Consent form_Virtual Survey_Spanish.docx C25b. (Recruitment 025) Household Consent form_Virtual Survey_Spanish	IC Document
C26a. (Recruitment 021) Household Survey Recruitment Guide-In person survey_v5_English.docx C26a. (Recruitment 021) Household Survey Recruitment Guide-In person survey_v5_English	IC Document
C26b. (Recruitment 021). Household Survey Recruitment Guide-In person_SPAN.docx C26b. (Recruitment 021). Household Survey Recruitment Guide-In person_SPAN	IC Document
C27a. (Recruitment 022) Household Fact Sheet Re In-Person Survey_v3_English.docx C27a. (Recruitment 022) Household Fact Sheet Re In-Person Survey_v3_English	IC Document
C27b. (Recruitment 022). Household Fact Sheet Re In-Person Survey_SPAN.docx C27b. (Recruitment 022). Household Fact Sheet Re In-Person Survey_SPAN	IC Document
C28a. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_v4_English.docx C28a. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_v4_English	IC Document
C28b. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_SPAN.docx C28b. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_SPAN	IC Document
C29. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7.docx C29. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Individuals/Households - Households

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-B5a. (Instrument E1) Household Survey_v12_English	B5a. (Instrument E1) Household Survey_v12_English.docx	No		Paper Only
Other-B5b. (Instrument E1) Household Survey_Spanish	B5b. (Instrument E1) Household Survey_Spanish.docx	No		Paper Only
Other-B6a. (Instrument E7) Household Survey Income Worksheet_v4_English	B6a. (Instrument E7) Household Survey Income Worksheet_v4_English.docx	Yes	Yes	Fillable Fileable
Other-B6b. (Instrument E7) Household Income Worksheet_Spanish	B6b. (Instrument E7) Household Income Worksheet_Spanish.docx	Yes	Yes	Fillable Fileable
Other-B7a. (Instrument E10) Instructions for Inc Documentation After Survey_v6_English	B7a. (Instrument E10) Instructions for Inc Documentation After Survey_v6_English.docx	Yes	Yes	Fillable Fileable
Other-B7b. (Instrument E10) Instructions for Inc Documentation_Spanish	B7b. (Instrument E10) Instructions for Inc Documentation_Spanish.docx	Yes	Yes	Fillable Fileable

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: 8,801

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	77,151	77,151
Annual IC Time Burden (Hours)	15,475	15,475
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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