Appendix C1. Survey Invitation (English)
OMB Number: 0584-XXXX
Expiration Date: XX/XX/20XX
NOTE TO OMB REVIEWERS: Survey recruitment materials will display county-specific graphical art. Bolivar County is included on materials for illustrative purposes.
We
need your help! Your household was randomly selected to participate
in an important study in [COUNTY] County for the U.S. Department of
Agriculture, the
Study of Food and Well-Being.
[COUNTY] County is one
of only six counties in the whole country
invited to participate in this study. We
cannot replace you—your viewpoint matters!
If
you agree to share your perspective, you will be asked to complete a
survey about your household’s food-related experiences,
benefits you may receive, and your overall health and well-being.
The survey should be completed by the adult who does most of the planning or preparing of meals for your household.
If eligible, you will receive a $35 Visa gift card after you complete the 35 minute survey.
Please
do one of three things to make your voice heard:
P articipate NOW Online
|
P articipate NOW by Phone
|
P
|
Username: [USERNAME] Password: [PASSWORD] |
Call toll-free at: 1-XXX-XXX-XXXX |
A representative from the Mathematica research team will visit you |
Your participation is voluntary, but very important. We are required by law to protect and keep your data private1. Your decision to participate will not affect any benefits that you or your household may receive.
A study brochure and $5 cash are included with this letter. If you have any questions or need assistance with accessing the web survey, please call us toll-free at 1-XXX-XXX-XXXX.
Sincerely,
---insert signature image here---
Kim McDonald
This
information is being collected to assist the Food and Nutrition
Service (FNS) in understanding the interrelated factors that affect
food insecurity and poverty. This is a voluntary collection and FNS
will use the information to aid in the administration of the
Supplemental Nutrition Assistance Program. This collection does
request 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 2 minutes (0.0334
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.
1 As described in the system of records notice (SORN) titled FNS 8 USDA/FNS Studies and Reports (published in the Federal Register on April 25, 1991, volume 56, pages 19078 – 19080), FNS and contractors working on their behalf may collect and analyze this survey information for research purposes and are required to have safeguards in place to keep data private.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 2023-08-25 |