State and Local Government

Assessment of Administrative Costs of Electronic Healthy Incentives Projects (eHIP)

OMB:

IC ID: 271789

Documents and Forms
Document Name
Document Type
Other-04_D. Electronic Letter to Sta
Other-04_D. Electronic Letter to Sta
Other-05_E. Reminder Electronic Lett
Other-05_E. Reminder Electronic Lett
Other-06_F. State Administrative Cos
Other-06_F. State Administrative Cos
Other-07_G. Incentive Report Templat
Other-07_G. Incentive Report Templat
Other-08_H. Retailer list
Other-08_H. Retailer list
Other-09_I.Electronic Letter with Re
Other-09_I.Electronic Letter with Re
Other-10_J.Electronic Letter with Re
Other-10_J.Electronic Letter with Re
Other-11_K.Electronic Letter with Re
Other-11_K.Electronic Letter with Re
Other-12_L. In-Depth Interview Proto
Other-12_L. In-Depth Interview Proto
Other-14_N. Interview Consent Form
Other-14_N. Interview Consent Form
Other-15_O. Interview Follow Up and
Other-15_O. Interview Follow Up and
Other-23_V. Pretest Protocol
Other-23_V. Pretest Protocol
Other-13_M. Interview Worksheets
Other-13_M. Interview Worksheets
Information Collection (IC) Details

View Information Collection (IC)

State and Local Government
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-04_D. Electronic Letter to States with Data Request 04_D. Electronic Letter to States with Data Request.docx Yes Yes Printable Only
Other-05_E. Reminder Electronic Letter to States with Data Request 05_E. Reminder Electronic Letter to States with Data Request.docx Yes Yes Printable Only
Other-06_F. State Administrative Cost Template 06_F. State Administrative Cost Template.xlsx Yes Yes Fillable Fileable
Other-07_G. Incentive Report Template 07_G. Incentive Report Template.xlsx Yes Yes Fillable Fileable
Other-08_H. Retailer list 08_H. Retailer list.xlsx Yes Yes Fillable Fileable
Other-09_I.Electronic Letter with Request to Schedule Interview - fns 09_I.Electronic Letter with Request to Schedule Interview - fns.docx Yes Yes Printable Only
Other-10_J.Electronic Letter with Reminder to Schedule Interview 10_J.Electronic Letter with Reminder to Schedule Interview.docx Yes Yes Printable Only
Other-11_K.Electronic Letter with Reminder about Interview 11_K.Electronic Letter with Reminder about Interview.docx Yes Yes Printable Only
Other-12_L. In-Depth Interview Protocol 12_L. In-Depth Interview Protocol.docx No   Paper Only
Other-14_N. Interview Consent Form 14_N. Interview Consent Form.docx Yes Yes Printable Only
Other-15_O. Interview Follow Up and Thank You Note 15_O. Interview Follow Up and Thank You Note.docx Yes Yes Printable Only
Other-23_V. Pretest Protocol 23_V. Pretest Protocol.docx Yes Yes Fillable Fileable
Other-13_M. Interview Worksheets 13_M. Interview Worksheets.xlsx Yes Yes Fillable Fileable

Income Security Food and Nutrition Assistance

 

12 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 90 0 90 0 0 0
Annual IC Time Burden (Hours) 93 0 93 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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