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-B6a. (Instrument E7) Household
Other-B6a. (Instrument E7) Household
Other-B6b. (Instrument E7) Household
Other-B6b. (Instrument E7) Household
Other-B7a. (Instrument E10) Instruct
Other-B7a. (Instrument E10) Instruct
Other-B7b. (Instrument E10) Instruct
Other-B7b. (Instrument E10) Instruct
Other-Appendix B5a. Household Survey
Other-Appendix B5a. Household Survey
Other-Appendix B5b. Household Survey
Other-Appendix B5b. Household Survey
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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-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
Other-Appendix B5a. Household Survey (English) Appendix B5a. Household Survey (English).docx No   Paper Only
Other-Appendix B5b. Household Survey (Spanish) Appendix B5b. Household Survey (Spanish).docx No   Paper Only

Income Security Food and Nutrition Assistance

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

8,801 0
   
Individuals or Households
 
   100 %

  Approved 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 75,951 0 0 0 0 75,951
Annual IC Time Burden (Hours) 15,385 0 0 0 0 15,385
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
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
C26. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7 C26. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7.docx 05/18/2022
Appendix C22a. Household Survey Recruitment Letter (English) Appendix C22a. Household Survey Recruitment Letter (English).docx 08/16/2022
Appendix C22b. Household Survey Recruitment Letter (Spanish) Appendix C22b. Household Survey Recruitment Letter (Spanish).docx 08/16/2022
Appendix C23a. Household Survey Recruitment Guide (English) Appendix C23a. Household Survey Recruitment Guide (English).docx 08/16/2022
Appendix C23b. Household Survey Recruitment Guide (Spanish) Appendix C23b. Household Survey Recruitment Guide (Spanish).docx 08/16/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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