Individuals/Households - Households

Fourth Access, Participation, Eligibility, and Certification Study Series (APEC IV)

OMB: 0584-0530

IC ID: 226896

Documents and Forms
Document Name
Document Type
Other-B5a. (Instrument E1) Household
Other-B5b. (Instrument E1) Household
Other-B6a. (Instrument E7) Household
Other-B6b. (Instrument E7) Household
Other-B7a. (Instrument E10) Instruct
Other-B7b. (Instrument E10) Instruct
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Individuals/Households - Households
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL 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

Income Security Food and Nutrition Assistance

FNS-8 USDA/FNS Studies and Reports  56 FR 19078

8,801 0
   
Individuals or Households
 
   100 %

  Requested 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 77,151 0 77,151 0 0 0
Annual IC Time Burden (Hours) 15,475 0 15,475 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
C16a. (Recruitment 018) Household Survey Brochure v3_English C16a. (Recruitment 018) Household Survey Brochure v3_English.pdf 02/09/2022
C16b. (Recruitment 018) Household Survey Brochure_Spanish C16b. (Recruitment 018) Household Survey Brochure_Spanish.pdf 02/09/2022
C22a. (Recruitment 017) Household Survey Recruitment Letter_v6_English C22a. (Recruitment 017) Household Survey Recruitment Letter_v6_English.docx 02/09/2022
C22b. (Recruitment 017) Household Survey Recruitment Letter_SPANISH C22b. (Recruitment 017) Household Survey Recruitment Letter_SPANISH.docx 02/09/2022
C23a. (Recruitment 019) Household Survey Recruitment Guide-Virtual Survey_v7_English C23a. (Recruitment 019) Household Survey Recruitment Guide-Virtual Survey_v7_English.docx 02/09/2022
C23b. (Recruitment 019). Household Survey Recruitment Guide-Virtual_SPANISH C23b. (Recruitment 019). Household Survey Recruitment Guide-Virtual_SPANISH.docx 02/09/2022
C24a. (Recruitment 020) Household Confirmation and Reminder of Virtual Survey_v6_English C24a. (Recruitment 020) Household Confirmation and Reminder of Virtual Survey_v6_English.docx 02/09/2022
C24b. (Recruitment 020). Household Confirmation and Reminder of Virtual Survey_Spanish C24b. (Recruitment 020). Household Confirmation and Reminder of Virtual Survey_Spanish.docx 02/09/2022
C25a. (Recruitment 025) Household Consent form_Virtual Survey_v3_English C25a. (Recruitment 025) Household Consent form_Virtual Survey_v3_English.docx 02/09/2022
C25b. (Recruitment 025) Household Consent form_Virtual Survey_Spanish C25b. (Recruitment 025) Household Consent form_Virtual Survey_Spanish.docx 02/09/2022
C26a. (Recruitment 021) Household Survey Recruitment Guide-In person survey_v5_English C26a. (Recruitment 021) Household Survey Recruitment Guide-In person survey_v5_English.docx 02/09/2022
C26b. (Recruitment 021). Household Survey Recruitment Guide-In person_SPAN C26b. (Recruitment 021). Household Survey Recruitment Guide-In person_SPAN.docx 02/09/2022
C27a. (Recruitment 022) Household Fact Sheet Re In-Person Survey_v3_English C27a. (Recruitment 022) Household Fact Sheet Re In-Person Survey_v3_English.docx 02/09/2022
C27b. (Recruitment 022). Household Fact Sheet Re In-Person Survey_SPAN C27b. (Recruitment 022). Household Fact Sheet Re In-Person Survey_SPAN.docx 02/09/2022
C28a. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_v4_English C28a. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_v4_English.docx 02/09/2022
C28b. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_SPAN C28b. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_SPAN.docx 02/09/2022
C29. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7 C29. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7.docx 02/09/2022
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