Appendix
B. Final State SNAP Agency Survey Instrument
OMB No. 0584-[NEW]
Assessing SNAP Participants’ Fitness for Work
Project Officer: Eric Sean Williams
Office of Policy Support
SNAP Research and Analysis Division
Food and Nutrition Service
U.S. Department of Agriculture
1320 Braddock Place
Alexandria, VA 22314
703.305.2640
The U.S. Department of Agriculture’s Food and Nutrition Service (FNS) seeks to learn more about how States assess physical or mental limitations when screening for exemptions from work requirements or determining good cause. FNS hired MEF Associates and Mathematica to conduct a study to understand the processes for determining physical or mental limitations. FNS is interested in understanding how States implement guidance on determining exemptions from work requirements or good cause due to a physical or mental limitation.
As part of this study, MEF Associates is conducting a survey of all State-level SNAP agencies. There are no right or wrong answers, and the purpose of this survey is not to audit or identify actions that may be correct or incorrect, but to help FNS understand how States make determinations about whether a SNAP applicant is fit for work.
The survey link may be shared with other staff in your agency who can contribute to your State’s response. This survey should take no more than 60 minutes to complete.
Your participation in this survey is voluntary. We will use all data we collect only for the purposes we describe. In the final report we will not link individual States to their responses, but instead will present aggregated survey data. However, the raw survey data will be submitted to FNS at the end of the study.
If you need additional information about the purpose of the study, please contact Eric Williams at [email protected]. If you have questions about or need assistance with the web survey, call [study phone number] or email us at [study email].
This information is being collected to assist the Food and Nutrition Service in understanding how States assess physical or mental limitations when screening for exemptions from work requirements or determining good cause. This is a voluntary collection and FNS will use the information to determine needs for technical assistance. This collection does not request any personally identifiable information under the Privacy Act of 1974. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-[xxxx]. The time required to complete this information collection is estimated to average 1.00 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306 ATTN: PRA (0584-xxxx). Do not return the completed form to this address.
By selecting the text below, you indicate that you have read this statement in its entirety and that you voluntarily agree to participate in the study.
I have read this statement in its entirety and voluntarily agree to participate in the study.
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General work requirements |
ABAWD work requirements |
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PROGRAMMING NOTE: If yes, skip to A.5. If no or “only for certain households”, go to A.4
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PROGRAMMING NOTE: If yes, skip to A.10. If no, go to A.9
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PROGRAMMING NOTE: If sometimes, go to A.15. If always, skip to A.16. If never, skip to A.17.
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PROGRAMMING NOTE: If sometimes, go to A.18. If always, skip to A.19. If never, skip to A.20
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Always |
Sometimes |
Never |
Eligibility frontline staff |
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Eligibility supervisors |
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Quality assurance staff |
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Other (please specify): |
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PROGRAMMING NOTE: If yes, see programming logic for A.27. If no, go to A.26.
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Always |
Sometimes |
Never |
Eligibility frontline staff |
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Eligibility supervisors |
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Quality assurance staff |
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Other (please specify): |
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PROGRAMMING NOTE: Only respondents that select “sometimes” for eligibility staff in A.24 receive A.27.
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PROGRAMMING NOTE: If yes, see programming logic for A.30. If no, go to A.29
PROGRAMMING NOTE: Only respondents that select “sometimes” for eligibility staff in A.24 and A.26 receive A.28.
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PROGRAMMING NOTE: Only respondents that select “sometimes” for eligibility supervisors in A.24 receive A.30.
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PROGRAMMING NOTE: Only respondents that select “sometimes” for eligibility supervisors in A.24 and A.26 receive A.31.
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PROGRAMMING NOTE: If yes, see programming logic for A.33. If no, go to A.32.
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PROGRAMMING NOTE: Only respondents that select “sometimes” for quality assurance staff in A.24 receive A.33.
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PROGRAMMING NOTE: If yes, see programming logic for A.36. If no, go to A.35. Respondents that select “sometimes” for quality assurance staff in A.26 receive A.35.
PROGRAMMING NOTE: Only respondents that select “sometimes” for quality assurance staff in A.24 and A.26 receive A.34.
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PROGRAMMING NOTE: Only respondents that select “sometimes” for “other” staff in A.24 receive A.36.
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PROGRAMMING NOTE: Only respondents that select “sometimes” for “other” staff in A.26 receive A.37.
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General work requirements |
ABAWD work requirements |
Whether or not the individual is exempt from the work requirement due to a physical or mental limitation |
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The specific physical or mental limitation |
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A description of the physical or mental limitation |
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The verification provided |
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Demographic data on the individual |
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Other |
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PROGRAMMING NOTE: Only respondents that select “Demographic data on the individual” in A.38 receive A.39A.39.
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General work requirement |
ABAWD work requirement |
When individuals recertify for their benefits |
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Based on information contained in the initial medical assessment (e.g., time for recovery) |
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Other |
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General work requirement |
ABAWD work requirement |
When individuals recertify for their benefits |
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When a good cause determination is made |
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When a suitable E&T component is not available |
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When an E&T participant receives a provider determination |
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When requested by individual |
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Other |
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State legislature |
State SNAP Agency |
Other |
The criteria for determining whether someone is exempt from general work requirements due to a physical or mental limitation |
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The information required to verify a physical or mental limitation that can exempt someone from general work requirements |
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Staff procedures for determining exemptions from general work requirements due to a physical or mental limitation |
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PROGRAMMING NOTE: Only the policies for which the respondent selected “other” will appear below.
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OPEN ENDED |
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OPEN ENDED |
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OPEN ENDED |
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Administrative data on determinations |
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Administrative data on appeals |
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Feedback from local administrators or supervisors |
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Federal regulation, statute, or guidance |
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Other (please specify): |
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The questions below pertain to the mandatory portion of your E&T program only. By “mandatory”, we mean the portion of your E&T program where participants are required to participate in SNAP E&T. This does not refer to programs where participants may fulfill their work requirements by participating in a variety of activities, of which SNAP E&T is one option.
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Always |
Sometimes |
Never |
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PROGRAMMING NOTE: If yes, skip to C.4. If no, go to C.3.
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PROGRAMMING NOTE: If yes, go to C.6. If no, skip to C.7
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PROGRAMMING NOTE: If yes, go to C.8. If no, skip to C.9.
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PROGRAMMING NOTE: If yes, go to C.10. If no, skip to C.11.
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Always |
Sometimes |
Never |
Eligibility frontline staff |
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Eligibility supervisors |
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Quality assurance staff |
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Other (please specify): |
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PROGRAMMING NOTE: If yes, skip to C.14 . If no, go to C.13
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Always |
Sometimes |
Never |
Eligibility frontline staff |
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Eligibility supervisors |
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Quality assurance staff |
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Other (please specify); |
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Thank you for participating in our survey! To help us better understand your State’s process for determining whether an individual is exempt from work requirements due to a physical or mental limitation, please upload the following documents using the link below:
{Outstanding Document 1 Based off Document Review}
{Outstanding Document 2 Based off Document Review}
{Outstanding Document 3 Based off Document Review}
Upload documents here
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |