Information Collection

FoodAPS Field Test - Respondents

IC 251684 under ICR 202202-0536-002 · OMB 0536-0077.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0536-0077 can be found here:

2022-06-10 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment B - Recruitment screener 01252022.docx	Other-Attachment B - Recruitment scr
Attachment B - Recruitment screener 01252022.docx	Other-Attachment B - Recruitment scr
Attachment B1 - Screenshots of Mail Household Screener (Web Version) 01042022.docx	Other-Attachment B1 - Screenshots of
Attachment B1 - Screenshots of Mail Household Screener (Web Version) 01042022.docx	Other-Attachment B1 - Screenshots of
Attachment J - Profile Questionnaire 02152022.docx	Other-Attachment J - Profile Questio
Attachment J - Profile Questionnaire 02152022.docx	Other-Attachment J - Profile Questio
Attachment J1 - Screenshots of FoodLogger Version of Profile Questionnaire 01042022.docx	Other-Attachment J1 - Screenshots of
Attachment J1 - Screenshots of FoodLogger Version of Profile Questionnaire 01042022.docx	Other-Attachment J1 - Screenshots of
Attachment J2 - Web Screenshots for Profile Questionnaire 01042022.docx	Other-Attachment J2 - Web Screenshot
Attachment J2 - Web Screenshots for Profile Questionnaire 01042022.docx	Other-Attachment J2 - Web Screenshot
Attachment L - Income Questionnaire 01042022.docx	Other-Attachment L - Income Question
Attachment L - Income Questionnaire 01042022.docx	Other-Attachment L - Income Question
Attachment L1 - Screenshots of FoodLogger Version of Income Questionnaire 01042022.docx	Other-Attachment L1 - Screenshots of
Attachment L1 - Screenshots of FoodLogger Version of Income Questionnaire 01042022.docx	Other-Attachment L1 - Screenshots of
Attachment L2 - Web Screenshots of Income Questionnaire 01042022.docx	Other-Attachment L2 - Web Screenshot
Attachment L2 - Web Screenshots of Income Questionnaire 01042022.docx	Other-Attachment L2 - Web Screenshot
Attachment M - Memory Jogger 10292021.docx	Other-Attachment M - Memory Jogger
Attachment M - Memory Jogger 10292021.docx	Other-Attachment M - Memory Jogger
Attachment O - Debriefing Interview 07272021.docx	Other-Attachment O - Debriefing Inte
Attachment O - Debriefing Interview 07272021.docx	Other-Attachment O - Debriefing Inte
Attachment R1 - Food Log Questionnaire_GoldStand 01042022.docx	Other-Attachment R1 - Food Log Quest
Attachment R1 - Food Log Questionnaire_GoldStand 01042022.docx	Other-Attachment R1 - Food Log Quest
Attachment R2 - Screenshots of FoodLogger Version of Food Log 01042022.docx	Other-Attachment R2 - Screenshots of
Attachment R2 - Screenshots of FoodLogger Version of Food Log 01042022.docx	Other-Attachment R2 - Screenshots of
Attachment R3 - Web Screenshots of Food Log 01042022.docx	Other-Attachment R3 - Web Screenshot
Attachment R3 - Web Screenshots of Food Log 01042022.docx	Other-Attachment R3 - Web Screenshot
Attachment C1 - Introductory letter 01252022.docx Attachment C1 - Introductory letter	IC Document
Attachment C1 - Introductory letter 01252022.docx Attachment C1 - Introductory letter	IC Document
Attachment D1 - In-person Screening Advance Letter 02152022.docx Attachment D1 - In-person Screening Advance Letter	IC Document
Attachment D1 - In-person Screening Advance Letter 02152022.docx Attachment D1 - In-person Screening Advance Letter	IC Document
Attachment D2 - Interviewer Authorization Letter 07272021.docx Attachment D2 - Interviewer Authorization Letter	IC Document
Attachment D2 - Interviewer Authorization Letter 07272021.docx Attachment D2 - Interviewer Authorization Letter	IC Document
Attachment D3 - Gated Community Letter 07272021.docx Attachment D3 - Gated Community Letter	IC Document
Attachment D3 - Gated Community Letter 07272021.docx Attachment D3 - Gated Community Letter	IC Document
Attachment D5 - Frequently Asked Questions and Responses 02152022.docx Attachment D5 - Frequently Asked Questions and Responses	IC Document
Attachment D5 - Frequently Asked Questions and Responses 02152022.docx Attachment D5 - Frequently Asked Questions and Responses	IC Document
Attachment E - In-person Household Screener 09082021.docx Attachment E - In-person Household Screener	IC Document
Attachment E - In-person Household Screener 09082021.docx Attachment E - In-person Household Screener	IC Document
Attachment F1 - Household Consent Form 01042022.docx Attachment F1 - Household Consent Form	IC Document
Attachment F1 - Household Consent Form 01042022.docx Attachment F1 - Household Consent Form	IC Document
Attachment F2 - Parental Consent Form 01042022.docx Attachment F2 - Parental Consent Form	IC Document
Attachment F2 - Parental Consent Form 01042022.docx Attachment F2 - Parental Consent Form	IC Document
Attachment F3 - Individual Assent Consent Form 01252022.docx Attachment F3 - Individual Assent Consent Form	IC Document
Attachment F3 - Individual Assent Consent Form 01252022.docx Attachment F3 - Individual Assent Consent Form	IC Document
Attachment G - Initial Household Interview 02152022.docx Attachment G - Initial Household Interview	IC Document
Attachment G - Initial Household Interview 02152022.docx Attachment G - Initial Household Interview	IC Document
Attachment H1 - NFS Field Test Overview (Interviewer Training Manual) 09082021.docx Attachment H1 - NFS Field Test Overview (Interviewer Training Manual)	IC Document
Attachment H1 - NFS Field Test Overview (Interviewer Training Manual) 09082021.docx Attachment H1 - NFS Field Test Overview (Interviewer Training Manual)	IC Document
Attachment H2 - Contacting Procedures (Interviewer Training Manual) 10292021.docx Attachment H2 - Contacting Procedures (Interviewer Training Manual)	IC Document
Attachment H2 - Contacting Procedures (Interviewer Training Manual) 10292021.docx Attachment H2 - Contacting Procedures (Interviewer Training Manual)	IC Document
Attachment H3 - Data Collection (Interviewer Training Manual) 11172021.docx Attachment H3 - Data Collection (Interviewer Training Manual)	IC Document
Attachment H3 - Data Collection (Interviewer Training Manual) 11172021.docx Attachment H3 - Data Collection (Interviewer Training Manual)	IC Document
Attachment H4 - Equipment (Interviewer Training Manual) 09082021.docx Attachment H4 - Equipment (Interviewer Training Manual)	IC Document
Attachment H4 - Equipment (Interviewer Training Manual) 09082021.docx Attachment H4 - Equipment (Interviewer Training Manual)	IC Document
Attachment H5 - Mobile Device User Guide (Interviewer Training Manual) 09082021.docx Attachment H5 - Mobile Device User Guide (Interviewer Training Manual)	IC Document
Attachment H5 - Mobile Device User Guide (Interviewer Training Manual) 09082021.docx Attachment H5 - Mobile Device User Guide (Interviewer Training Manual)	IC Document
Attachment H6 - Quality Control (Interviewer Training Manual) 09082021.docx Attachment H6 - Quality Control (Interviewer Training Manual)	IC Document
Attachment H6 - Quality Control (Interviewer Training Manual) 09082021.docx Attachment H6 - Quality Control (Interviewer Training Manual)	IC Document
Attachment H7 - Report Calls (Interviewer Training Manual) 09082021.docx Attachment H7 - Report Calls (Interviewer Training Manual)	IC Document
Attachment H7 - Report Calls (Interviewer Training Manual) 09082021.docx Attachment H7 - Report Calls (Interviewer Training Manual)	IC Document
Attachment H8 - Administrative Procedures (Interviewer Training Manual) 09082021.docx Attachment H8 - Administrative Procedures (Interviewer Training Manual)	IC Document
Attachment H8 - Administrative Procedures (Interviewer Training Manual) 09082021.docx Attachment H8 - Administrative Procedures (Interviewer Training Manual)	IC Document
Attachment I1 - How to Connect a Mi-Fi & Barcode Scanner 10292021.docx Attachment I1 - How to Connect a Mi-Fi & Barcode Scanner	IC Document
Attachment I1 - How to Connect a Mi-Fi & Barcode Scanner 10292021.docx Attachment I1 - How to Connect a Mi-Fi & Barcode Scanner	IC Document
Attachment I2 - Household Equipment Form 10292021.docx Attachment I2 - Household Equipment Form	IC Document
Attachment I2 - Household Equipment Form 10292021.docx Attachment I2 - Household Equipment Form	IC Document
Attachment I3 - Downloading and Installing the FoodLogger 10292021.pdf Attachment I3 - Downloading and Installing the FoodLogger	IC Document
Attachment I3 - Downloading and Installing the FoodLogger 10292021.pdf Attachment I3 - Downloading and Installing the FoodLogger	IC Document
Attachment K - Interviewer Observations 07272021.docx Attachment K - Interviewer Observations	IC Document
Attachment K - Interviewer Observations 07272021.docx Attachment K - Interviewer Observations	IC Document
Attachment N - Electronic Text and e-mail Communications 02152022.docx Attachment N - Electronic Text and e-mail Communications	IC Document
Attachment N - Electronic Text and e-mail Communications 02152022.docx Attachment N - Electronic Text and e-mail Communications	IC Document
Attachment Q - What to Report and What Not to Report 10292021.pdf Attachment Q - What to Report and What Not to Report	IC Document
Attachment Q - What to Report and What Not to Report 10292021.pdf Attachment Q - What to Report and What Not to Report	IC Document
Attachment V1 - Welcome to NFS Video Script 10292021.docx Attachment V1 - Welcome to NFS Video Script	IC Document
Attachment V1 - Welcome to NFS Video Script 10292021.docx Attachment V1 - Welcome to NFS Video Script	IC Document
Attachment V2 - Getting Started Video Script 10292021.docx Attachment V2 - Getting Started Video Script	IC Document
Attachment V2 - Getting Started Video Script 10292021.docx Attachment V2 - Getting Started Video Script	IC Document
Attachment V3 - Entering Grocery Store Food and Drink 10292021.docx Attachment V3 - Entering Grocery Store Food and Drink	IC Document
Attachment V3 - Entering Grocery Store Food and Drink 10292021.docx Attachment V3 - Entering Grocery Store Food and Drink	IC Document
Attachment V4 - Entering Restaurant Food and Drink Video Script 10292021.docx Attachment V4 - Entering Restaurant Food and Drink Video Script	IC Document
Attachment V4 - Entering Restaurant Food and Drink Video Script 10292021.docx Attachment V4 - Entering Restaurant Food and Drink Video Script	IC Document
Attachment V5 - Completing Profile and Income Questionnaires Video Script 10292021.docx Attachment V5 - Completing Profile and Income Questionnaires Video Script	IC Document
Attachment V5 - Completing Profile and Income Questionnaires Video Script 10292021.docx Attachment V5 - Completing Profile and Income Questionnaires Video Script	IC Document
Attachment V6 - Completing the Day Overview Video Script 10292021.docx Attachment V6 - Completing the Day Overview Video Script	IC Document
Attachment V6 - Completing the Day Overview Video Script 10292021.docx Attachment V6 - Completing the Day Overview Video Script	IC Document
Attachment V7 - Grocery Store Purchase Video Script 10292021.docx Attachment V7 - Grocery Store Purchase Video Script	IC Document
Attachment V7 - Grocery Store Purchase Video Script 10292021.docx Attachment V7 - Grocery Store Purchase Video Script	IC Document
Attachment V8 - How to Report Meals from a Fast Food Restuarant Video Script 10292021.docx Attachment V8 - How to Report Meals from a Fast Food Restuarant Video Script	IC Document
Attachment V8 - How to Report Meals from a Fast Food Restuarant Video Script 10292021.docx Attachment V8 - How to Report Meals from a Fast Food Restuarant Video Script	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

FoodAPS Field Test - 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-Attachment B - Recruitment screener	Attachment B - Recruitment screener 01252022.docx	Yes	Yes	Fillable Fileable
Other-Attachment B1 - Screenshots of Mail Household Screener (Web Version	Attachment B1 - Screenshots of Mail Household Screener (Web Version) 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment J - Profile Questionnaire	Attachment J - Profile Questionnaire 02152022.docx	Yes	Yes	Fillable Fileable
Other-Attachment J1 - Screenshots of FoodLogger Version of Profile Questionnaire	Attachment J1 - Screenshots of FoodLogger Version of Profile Questionnaire 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment J2 - Web Screenshots for Profile Questionnaire	Attachment J2 - Web Screenshots for Profile Questionnaire 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment L - Income Questionnaire	Attachment L - Income Questionnaire 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment L1 - Screenshots of FoodLogger Version of Income Questionnaire	Attachment L1 - Screenshots of FoodLogger Version of Income Questionnaire 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment L2 - Web Screenshots of Income Questionnaire	Attachment L2 - Web Screenshots of Income Questionnaire 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment M - Memory Jogger	Attachment M - Memory Jogger 10292021.docx	No		Printable Only
Other-Attachment O - Debriefing Interview	Attachment O - Debriefing Interview 07272021.docx	Yes	Yes	Fillable Printable
Other-Attachment R1 - Food Log Questionnaire_GoldStand	Attachment R1 - Food Log Questionnaire_GoldStand 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment R2 - Screenshots of FoodLogger Version of Food Log	Attachment R2 - Screenshots of FoodLogger Version of Food Log 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment R3 - Web Screenshots of Food Log	Attachment R3 - Web Screenshots of Food Log 01042022.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:

FR Citation:

Number of Respondents: 430

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	430	430
Annual IC Time Burden (Hours)	2,718	2,718
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.