Information Collection

Individuals and Households

IC 258078 under ICR 202303-0584-004 · OMB 0584-0680.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0680 can be found here:

2024-06-14 - No material or nonsubstantive change to a currently approved collection
2023-11-28 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
E5.1 Participant Survey Advance Letter.docx	Other-E5.1 Participant Survey Advanc
E5.1 Participant Survey Advance Letter.docx	Other-E5.1 Participant Survey Advanc
E5.2 Participant Survey Initial Email_Text.docx	Other-E5.2 Participant Survey Initia
E5.2 Participant Survey Initial Email_Text.docx	Other-E5.2 Participant Survey Initia
F1. Participant Focus Group Discussion Guide.docx	Other-F1. Participant Focus Group Di
F1. Participant Focus Group Discussion Guide.docx	Other-F1. Participant Focus Group Di
F2.1 Participant Focus Group Recruitment Email_Text.docx	Other-F2.1 Participant Focus Group R
F2.1 Participant Focus Group Recruitment Email_Text.docx	Other-F2.1 Participant Focus Group R
F3.1. Participant FAQ.docx	Other-F3.1. Participant FAQ
F3.1. Participant FAQ.docx	Other-F3.1. Participant FAQ
G2.1 Participant IDI Recruitment Email_Text.docx	Other-G2.1 Participant IDI Recruitme
G2.1 Participant IDI Recruitment Email_Text.docx	Other-G2.1 Participant IDI Recruitme
E1.1 Colorado Participant Survey Specifications.docx	Other-E1.1 Colorado Participant Surv
E1.1 Colorado Participant Survey Specifications.docx	Other-E1.1 Colorado Participant Surv
E1.2 Colorado Participant Survey Specifications_Spanish.docx	Other-E1.2 Colorado Participant Surv
E1.2 Colorado Participant Survey Specifications_Spanish.docx	Other-E1.2 Colorado Participant Surv
E1.3 Colorado Participant Survey Screenshots.docx	Other-E1.3 Colorado Participant Surv
E1.3 Colorado Participant Survey Screenshots.docx	Other-E1.3 Colorado Participant Surv
E1.4 Colorado Participant Survey Screenshots_Spanish.docx	Other-E1.4 Colorado Participant Surv
E1.4 Colorado Participant Survey Screenshots_Spanish.docx	Other-E1.4 Colorado Participant Surv
E2.1 Massachusetts Participant Survey Specifications.docx	Other-E2.1 Massachusetts Participant
E2.1 Massachusetts Participant Survey Specifications.docx	Other-E2.1 Massachusetts Participant
E2.2 Massachusetts Participant Survey Specifications_Spanish.docx	Other-E2.2 Massachusetts Participant
E2.2 Massachusetts Participant Survey Specifications_Spanish.docx	Other-E2.2 Massachusetts Participant
E2.3 Massachusetts Participant Survey Screenshots.docx	Other-E2.3 Massachusetts Participant
E2.3 Massachusetts Participant Survey Screenshots.docx	Other-E2.3 Massachusetts Participant
E2.4 Massachusetts Participant Survey Screenshots_Spanish.docx	Other-E2.4 Massachusetts Participant
E2.4 Massachusetts Participant Survey Screenshots_Spanish.docx	Other-E2.4 Massachusetts Participant
E3.1 Connecticut Participant Survey Specifications.docx	Other-E3.1 Connecticut Participant S
E3.1 Connecticut Participant Survey Specifications.docx	Other-E3.1 Connecticut Participant S
E3.2 Connecticut Participant Survey Specifications_Spanish.docx	Other-E3.2 Connecticut Participant S
E3.2 Connecticut Participant Survey Specifications_Spanish.docx	Other-E3.2 Connecticut Participant S
E3.3 Connecticut Participant Survey Screenshots.docx	Other-E3.3 Connecticut Participant S
E3.3 Connecticut Participant Survey Screenshots.docx	Other-E3.3 Connecticut Participant S
E3.4 Connecticut Participant Survey Screenshots_Spanish.docx	Other-E3.4 Connecticut Participant S
E3.4 Connecticut Participant Survey Screenshots_Spanish.docx	Other-E3.4 Connecticut Participant S
E4.1 Rhode Island Participant Survey_Specifications.docx	Other-E4.1 Rhode Island Participant
E4.1 Rhode Island Participant Survey_Specifications.docx	Other-E4.1 Rhode Island Participant
E4.2 Rhode Island Participant Survey Specifications_Spanish.docx	Other-E4.2 Rhode Island Participant
E4.2 Rhode Island Participant Survey Specifications_Spanish.docx	Other-E4.2 Rhode Island Participant
E4.3 Rhode Island Participant Survey Screenshots.docx	Other-E4.3 Rhode Island Participant
E4.3 Rhode Island Participant Survey Screenshots.docx	Other-E4.3 Rhode Island Participant
E4.4 Rhode Island Participant Survey Screenshots_Spanish.docx	Other-E4.4 Rhode Island Participant
E4.4 Rhode Island Participant Survey Screenshots_Spanish.docx	Other-E4.4 Rhode Island Participant
F1.1 Participant Focus Group Information Form.docx	Other-F1.1 Participant Focus Group I
F1.1 Participant Focus Group Information Form.docx	Other-F1.1 Participant Focus Group I
G1. Participant In-Depth Interview Discussion Guide.docx	Other-G1. Participant In-Depth Inter
G1. Participant In-Depth Interview Discussion Guide.docx	Other-G1. Participant In-Depth Inter
R. Connecticut Evaluation Consent Form.docx	Other-R. Connecticut Evaluation Cons
R. Connecticut Evaluation Consent Form.docx	Other-R. Connecticut Evaluation Cons
B2. Intervention Outreach Materials - OIRA_Rev.docx	Other-B2. Intervention Outreach Mate
B2. Intervention Outreach Materials - OIRA_Rev.docx	Other-B2. Intervention Outreach Mate
B3. Intervention Assessment Materials - OIRA_Rev.docx	Other-B3. Intervention Assessment Ma
B3. Intervention Assessment Materials - OIRA_Rev.docx	Other-B3. Intervention Assessment Ma
E5.3 Participant Survey Reminder Email_Text.docx E5.3 Participant Survey Reminder Email_Text	IC Document
E5.3 Participant Survey Reminder Email_Text.docx E5.3 Participant Survey Reminder Email_Text	IC Document
E5.4 Participant Survey Reminder Letter.docx E5.4 Participant Survey Reminder Letter	IC Document
E5.4 Participant Survey Reminder Letter.docx E5.4 Participant Survey Reminder Letter	IC Document
G2.2 Participant IDI Confirmation and Reminder Email_Text.docx G2.2 Participant IDI Confirmation and Reminder Email_Text	IC Document
G2.2 Participant IDI Confirmation and Reminder Email_Text.docx G2.2 Participant IDI Confirmation and Reminder Email_Text	IC Document
E5.5 Participant Survey Reminder Postcard.docx E5.5 Participant Survey Reminder Postcard	IC Document
E5.5 Participant Survey Reminder Postcard.docx E5.5 Participant Survey Reminder Postcard	IC Document
F2.2 Participant Focus Group Confirmation and Reminder Email_Text.docx F2.2 Participant Focus Group Confirmation and Reminder Email_Text	IC Document
F2.2 Participant Focus Group Confirmation and Reminder Email_Text.docx F2.2 Participant Focus Group Confirmation and Reminder Email_Text	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Individuals and Households

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-E5.1 Participant Survey Advance Letter	E5.1 Participant Survey Advance Letter.docx	Yes	Yes	Printable Only
Other-E5.2 Participant Survey Initial Email_Text	E5.2 Participant Survey Initial Email_Text.docx	Yes	Yes	Printable Only
Other-F1. Participant Focus Group Discussion Guide	F1. Participant Focus Group Discussion Guide.docx	No		Paper Only
Other-F2.1 Participant Focus Group Recruitment Email_Text	F2.1 Participant Focus Group Recruitment Email_Text.docx	Yes	No	Printable Only
Other-F3.1. Participant FAQ	F3.1. Participant FAQ.docx	Yes	No	Printable Only
Other-G2.1 Participant IDI Recruitment Email_Text	G2.1 Participant IDI Recruitment Email_Text.docx	Yes	Yes	Printable Only
Other-E1.1 Colorado Participant Survey Specifications	E1.1 Colorado Participant Survey Specifications.docx	Yes	Yes	Printable Only
Other-E1.2 Colorado Participant Survey Specifications_Spanish	E1.2 Colorado Participant Survey Specifications_Spanish.docx	Yes	Yes	Printable Only
Other-E1.3 Colorado Participant Survey Screenshots	E1.3 Colorado Participant Survey Screenshots.docx	Yes	Yes	Fillable Fileable
Other-E1.4 Colorado Participant Survey Screenshots_Spanish	E1.4 Colorado Participant Survey Screenshots_Spanish.docx	Yes	Yes	Fillable Fileable
Other-E2.1 Massachusetts Participant Survey Specifications	E2.1 Massachusetts Participant Survey Specifications.docx	Yes	Yes	Fillable Fileable
Other-E2.2 Massachusetts Participant Survey Specifications_Spanish	E2.2 Massachusetts Participant Survey Specifications_Spanish.docx	Yes	Yes	Fillable Fileable
Other-E2.3 Massachusetts Participant Survey Screenshots	E2.3 Massachusetts Participant Survey Screenshots.docx	Yes	Yes	Fillable Fileable
Other-E2.4 Massachusetts Participant Survey Screenshots_Spanish	E2.4 Massachusetts Participant Survey Screenshots_Spanish.docx	Yes	Yes	Fillable Fileable
Other-E3.1 Connecticut Participant Survey Specifications	E3.1 Connecticut Participant Survey Specifications.docx	Yes	Yes	Fillable Fileable
Other-E3.2 Connecticut Participant Survey Specifications_Spanish	E3.2 Connecticut Participant Survey Specifications_Spanish.docx	Yes	Yes	Fillable Fileable
Other-E3.3 Connecticut Participant Survey Screenshots	E3.3 Connecticut Participant Survey Screenshots.docx	Yes	Yes	Fillable Fileable
Other-E3.4 Connecticut Participant Survey Screenshots_Spanish	E3.4 Connecticut Participant Survey Screenshots_Spanish.docx	Yes	Yes	Fillable Fileable
Other-E4.1 Rhode Island Participant Survey_Specifications	E4.1 Rhode Island Participant Survey_Specifications.docx	Yes	Yes	Fillable Fileable
Other-E4.2 Rhode Island Participant Survey Specifications_Spanish	E4.2 Rhode Island Participant Survey Specifications_Spanish.docx	Yes	Yes	Fillable Fileable
Other-E4.3 Rhode Island Participant Survey Screenshots	E4.3 Rhode Island Participant Survey Screenshots.docx	Yes	Yes	Fillable Fileable
Other-E4.4 Rhode Island Participant Survey Screenshots_Spanish	E4.4 Rhode Island Participant Survey Screenshots_Spanish.docx	Yes	Yes	Fillable Fileable
Other-F1.1 Participant Focus Group Information Form	F1.1 Participant Focus Group Information Form.docx	Yes	Yes	Printable Only
Other-G1. Participant In-Depth Interview Discussion Guide	G1. Participant In-Depth Interview Discussion Guide.docx	Yes	No	Printable Only
Other-R. Connecticut Evaluation Consent Form	R. Connecticut Evaluation Consent Form.docx	Yes	Yes	Fillable Printable
Other-B3. Intervention Assessment Materials - OIRA_Rev	B3. Intervention Assessment Materials - OIRA_Rev.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: 49,052

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	Previously Approved
Annual Number of Responses for this IC	172,384	172,384
Annual IC Time Burden (Hours)	14,387	14,387
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
E5.3 Participant Survey Reminder Email_Text	E5.3 Participant Survey Reminder Email_Text.docx	01/25/2023
E5.4 Participant Survey Reminder Letter	E5.4 Participant Survey Reminder Letter.docx	01/25/2023
G2.2 Participant IDI Confirmation and Reminder Email_Text	G2.2 Participant IDI Confirmation and Reminder Email_Text.docx	01/25/2023
E5.5 Participant Survey Reminder Postcard	E5.5 Participant Survey Reminder Postcard.docx	02/09/2023
F2.2 Participant Focus Group Confirmation and Reminder Email_Text	F2.2 Participant Focus Group Confirmation and Reminder Email_Text.docx	03/30/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.