State and Local Government Respondents

Improving Coordination Between SNAP and Medicaid in State Agencies (New)

OMB: 0584-0694

IC ID: 263708

Documents and Forms

Document Name Document Type
Appendix B. State Administrator Interview Guide.docx Other-Appendix B. State Administrato
Appendix B. State Administrator Interview Guide.docx Other-Appendix B. State Administrato
Appendix C. Local Administrator Interview Guide.docx Other-Appendix C. Local Administrato
Appendix C. Local Administrator Interview Guide.docx Other-Appendix C. Local Administrato
Appendix D. State Information Technology Director or Manager Interview Guide.docx Other-Appendix D. State Information
Appendix D. State Information Technology Director or Manager Interview Guide.docx Other-Appendix D. State Information
Appendix E. Frontline Staff Interview Guide.docx Other-Appendix E. Frontline Staff In
Appendix E. Frontline Staff Interview Guide.docx Other-Appendix E. Frontline Staff In
Appendix G. Informed Consent Script.docx Other-Appendix G. Informed Consent S
Appendix G. Informed Consent Script.docx Other-Appendix G. Informed Consent S
Appendix I. Case Study Recruitment Email from FNS or CMS to SNAP or Medicaid Director_11.8 Updates.docx Other-Appendix I. Case Study Recruit
Appendix I. Case Study Recruitment Email from FNS or CMS to SNAP or Medicaid Director_11.8 Updates.docx Other-Appendix I. Case Study Recruit
Appendix J. Case Study Recruitment Email from Project Team to SNAP Director.docx Other-Appendix J. Case Study Recruit
Appendix J. Case Study Recruitment Email from Project Team to SNAP Director.docx Other-Appendix J. Case Study Recruit
Appendix K. Case Study Recruitment Email from Project Team to Medicaid Director.docx Other-Appendix K. Case Study Recruit
Appendix K. Case Study Recruitment Email from Project Team to Medicaid Director.docx Other-Appendix K. Case Study Recruit

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State and Local Government Respondents	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix B. State Administrator Interview Guide	Appendix B. State Administrator Interview Guide.docx	No		Paper Only
Other-Appendix C. Local Administrator Interview Guide	Appendix C. Local Administrator Interview Guide.docx	No		Paper Only
Other-Appendix D. State Information Technology Director or Manager Interview Guide	Appendix D. State Information Technology Director or Manager Interview Guide.docx	No		Paper Only
Other-Appendix E. Frontline Staff Interview Guide	Appendix E. Frontline Staff Interview Guide.docx	No		Paper Only
Other-Appendix G. Informed Consent Script	Appendix G. Informed Consent Script.docx	No		Paper Only
Other-Appendix I. Case Study Recruitment Email from FNS or CMS to SNAP or Medicaid Director_11.8 Updates	Appendix I. Case Study Recruitment Email from FNS or CMS to SNAP or Medicaid Director_11.8 Updates.docx	Yes	No	Printable Only
Other-Appendix J. Case Study Recruitment Email from Project Team to SNAP Director	Appendix J. Case Study Recruitment Email from Project Team to SNAP Director.docx	Yes	No	Printable Only
Other-Appendix K. Case Study Recruitment Email from Project Team to Medicaid Director	Appendix K. Case Study Recruitment Email from Project Team to Medicaid Director.docx	Yes	No	Printable Only

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: 105	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	230	230
Annual IC Time Burden (Hours)	123	123
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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