Information Collection

State, Local, or Tribal Government

IC 258101 under ICR 202403-0584-006 · OMB 0584-0682.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0682 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
B. SNAP Agency Data Request.docx	Other-B. SNAP Agency Data Request
B. SNAP Agency Data Request.docx	Other-B. SNAP Agency Data Request
I. Police Station Letter.docx	Other-I. Police Station Letter
I. Police Station Letter.docx	Other-I. Police Station Letter
R. Study Description.docx	Other-R. Study Description
R. Study Description.docx	Other-R. Study Description
Q1. Focus Group Consent Form.docx	Other-Q1. Focus Group Consent Form
Q1. Focus Group Consent Form.docx	Other-Q1. Focus Group Consent Form
Q3. Focus Group Invitation.docx	Other-Q3. Focus Group Invitation
Q3. Focus Group Invitation.docx	Other-Q3. Focus Group Invitation
Q2. Focus Group Discussion Guide.docx	Other-Q2. Focus Group Discussion Gui
Q2. Focus Group Discussion Guide.docx	Other-Q2. Focus Group Discussion Gui

IC Title:

State, Local, or Tribal Government

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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-B. SNAP Agency Data Request	B. SNAP Agency Data Request.docx	Yes	No	Printable Only
Other-I. Police Station Letter	I. Police Station Letter.docx	No		Paper Only
Other-R. Study Description	R. Study Description.docx	Yes	No	Printable Only
Other-Q1. Focus Group Consent Form	Q1. Focus Group Consent Form.docx	Yes	Yes	Printable Only
Other-Q3. Focus Group Invitation	Q3. Focus Group Invitation.docx	Yes	No	Printable Only
Other-Q2. Focus Group Discussion Guide	Q2. Focus Group Discussion Guide.docx	No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	117	117
Annual IC Time Burden (Hours)	77	77
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.