Information Collection

Individuals and Households Respondents

IC 247754 under ICR 202204-0584-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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
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
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
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
H8_Child Food Diary_Spanish_revised 2021.10.08_clean.docx	Other-H8_Child Food Diary_Spanish_re
D1_Recruitment Website.docx	Other-D1_Recruitment Website
D1_Recruitment Website.docx	Other-D1_Recruitment Website
D2_Recruitment Website - Spanish.docx	Other-D2_Recruitment Website - Spani
D2_Recruitment Website - Spanish.docx	Other-D2_Recruitment Website - Spani
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: 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-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-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
Other-D1_Recruitment Website	D1_Recruitment Website.docx	Yes	Yes	Fillable Fileable
Other-D2_Recruitment Website - Spanish	D2_Recruitment Website - 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: 8,441

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	Previously Approved
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.