Businesses

N. Interview Consent Form

OMB Number: 0584-NEW Expiration Date: MM/DD/20YY

ASSESSMENT OF THE ADMINISTRATIVE COSTS OF ELECTRONIC HEALTHY INCENTIVES PROJECTS

Video Interview Consent Form

The Food and Nutrition Service (FNS) is interested in understanding the costs of integrating SNAP nutrition incentive programs into State EBT systems. FNS is also interested in understanding how these costs are different from the costs of setting up and running incentive programs that aren’t integrated in EBT systems. FNS has contracted Westat to conduct a study that will collect cost data on the eHIP projects and break down these costs by what the cost is for (for example, changing EBT systems), who is incurring this cost (the State, EBT processors, retailers, or someone else), and whether it reflects a one-time cost of setting up the project or an ongoing cost of administering eHIP. Westat will be producing a report that discusses these costs across all three States in the project as well as estimates of the costs of nationwide implementation of eHIP and estimates of how eHIP costs compare with the costs of non-EBT integrated nutrition incentive projects.

Information to be collected

During our interview, we’d like to ask you more about the data that you or your organization submitted, any additional sources of funding outside the eHIP grant that you may have used for your work related to the eHIP project, any unexpected costs that may have arisen, and any lessons you’ve learned related to costs so far.

Risks and privacy

There is little risk to being part of this study. We use all data we collect only for the purposes we describe. FNS has directed all the eHIP States to participate in the cost study. While we will be comparing the costs of the eHIP projects across States, the results of this study will have no impact on the eHIP project funding or on any future funding each State receives. FNS knows that we will be interviewing individuals from all the eHIP States. However, we will not be revealing to FNS the names or specific positions of the people interviewed in each State. We will be presenting the results of these interviews in aggregate. Your name will not be linked to your responses. In our reports, we may include direct quotes, but these will be presented without the speaker’s name, position, organization, or State so that report readers should not be able to identify speakers.

Study costs and compensation

These is no cost to you to participate apart from the time you spend with us for this interview. There is no compensation. The interview should take about 60 minutes.

Voluntary participation

Your participation is entirely voluntary. Refusal to participate will not have any impact on your position, your organization, or your State. You can take a break, skip questions, say something off the record, or stop participating at any time.

Questions

If you have any questions about your rights and welfare as a research participant, please call the Westat Human Subjects Protections office at 1-888-920-7631. Please leave a message with your first name, the name of the research study you are calling about, which is eHIP, and a phone number beginning with the area code. Someone will return your call as soon as possible.

For questions about this study, please contact Maeve Gearing at 1-919-323-7735 or at [email protected]

This information is being collected to provide the Food and Nutrition Service (FNS) with key cost information on Electronic Healthy Incentives Projects conducted by SNAP State agencies. This is a voluntary collection, and FNS will use the information to examine costs of Electronic Healthy Incentives Projects for SNAP. This collection requests 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-NEW. The time required to complete this information collection is estimated to average 1.5 hours (90 minutes) per response. 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 22314 ATTN: PRA (0584-NEW). Do not return the completed form to this address. If you have any questions, please contact the FNS Project Officer for this project, Kathleen Patton, at [email protected] or 703-305-2813.