Information Collection

Usability and Cognitive Evaluation for the Data Collection Instrument of FoodAPS-2 Pilot Study

IC 264443 under ICR 202508-0607-002 · OMB 0607-0725.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0607-0725 can be found here:

2025-12-30 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Usability and Cognitive Evaluation for the Data Collection Instrument of FoodAPS-2 Pilot Study	Form and Instruction
Form 1 Income and Profile Questionnaire Usability and Cognitive Evaluation for the Data Collection Instrument of FoodAPS-2 Pilot Study	Form and Instruction
Form 2 Initial Interview Usability and Cognitive Evaluation for the Data Collection Instrument of FoodAPS-2 Pilot Study	Form and Instruction
Form 3 Food Log Questionnaire Usability and Cognitive Evaluation for the Data Collection Instrument of FoodAPS-2 Pilot Study	Form and Instruction
Form 4 Debriefing Interview Usability and Cognitive Evaluation for the Data Collection Instrument of FoodAPS-2 Pilot Study	Form and Instruction
1 Income and Profile Questionnaire Appendix Q Income and Profile Questionnaire.docx	Form and Instruction
1 Income and Profile Questionnaire Appendix Q Income and Profile Questionnaire.docx	Form and Instruction
2 Initial Interview Appendix R Initial Interview.docx	Form and Instruction
2 Initial Interview Appendix R Initial Interview.docx	Form and Instruction
3 Food Log Questionnaire Appendix S Food Log Questionnaire.docx	Form and Instruction
3 Food Log Questionnaire Appendix S Food Log Questionnaire.docx	Form and Instruction
4 Debriefing Interview Appendix T Debriefing Interview_clean_01102024.docx	Form and Instruction
4 Debriefing Interview Appendix T Debriefing Interview_clean_01102024.docx	Form and Instruction
OMB request for FoodAPS-2 Pilot Test usability evaluation.docx OMB Memo	IC Document
OMB request for FoodAPS-2 Pilot Test usability evaluation.docx OMB Memo	IC Document
Appendix A Instructions for Installing Microsoft Teams.docx Instructions for Installing Microsoft Teams	IC Document
Appendix A Instructions for Installing Microsoft Teams.docx Instructions for Installing Microsoft Teams	IC Document
Appendix B Participant Recruitment Advertisement Script_corrected.docx Participant Recruitment Advertisement Script	IC Document
Appendix B Participant Recruitment Advertisement Script_corrected.docx Participant Recruitment Advertisement Script	IC Document
Appendix C Participant Recruitment Flyer_clean_01102024.docx Participant Recruitment Flyer	IC Document
Appendix C Participant Recruitment Flyer_clean_01102024.docx Participant Recruitment Flyer	IC Document
Appendix D Screener Questionnaire for Participant Recruitment_clean_01102024.docx Screener Questionnaire for Participant Recruitment	IC Document
Appendix D Screener Questionnaire for Participant Recruitment_clean_01102024.docx Screener Questionnaire for Participant Recruitment	IC Document
Appendix E Round-1 Protocol_corrected.docx Round-1 Protocol	IC Document
Appendix E Round-1 Protocol_corrected.docx Round-1 Protocol	IC Document
Appendix F Adult Consent Form_clean_01102024.docx Adult Consent Form	IC Document
Appendix F Adult Consent Form_clean_01102024.docx Adult Consent Form	IC Document
Appendix G Consent Form for Minors_clean_01102024.docx Consent Form for Minors	IC Document
Appendix G Consent Form for Minors_clean_01102024.docx Consent Form for Minors	IC Document
Appendix H Demographic Questionnaire.docx Demographic Questionnaire	IC Document
Appendix H Demographic Questionnaire.docx Demographic Questionnaire	IC Document
Appendix I Satisfaction Questionnaire.docx Satisfaction Questionnaire	IC Document
Appendix I Satisfaction Questionnaire.docx Satisfaction Questionnaire	IC Document
Appendix J Incentive Voucher.docx Incentive Voucher	IC Document
Appendix J Incentive Voucher.docx Incentive Voucher	IC Document
Appendix K Food-at-Home (FAH) Use Case.docx Food-at-Home (FAH) Use Case	IC Document
Appendix K Food-at-Home (FAH) Use Case.docx Food-at-Home (FAH) Use Case	IC Document
Appendix L Food-away-from-Home (FAFH) Use Case.docx Food-away-from-Home (FAFH) Use Case	IC Document
Appendix L Food-away-from-Home (FAFH) Use Case.docx Food-away-from-Home (FAFH) Use Case	IC Document
Appendix M School-Meal Use Cases.docx School-Meal Use Cases	IC Document
Appendix M School-Meal Use Cases.docx School-Meal Use Cases	IC Document
Appendix N Critical Tasks.docx Critical Tasks	IC Document
Appendix N Critical Tasks.docx Critical Tasks	IC Document
Appendix O Round-2&3 Protocol_corrected.docx Round-2&3 Protocol	IC Document
Appendix O Round-2&3 Protocol_corrected.docx Round-2&3 Protocol	IC Document
Appendix P Quiz for Training Assessment.docx Quiz for Training Assessment	IC Document
Appendix P Quiz for Training Assessment.docx Quiz for Training Assessment	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Usability and Cognitive Evaluation for the Data Collection Instrument of FoodAPS-2 Pilot Study

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form and Instruction	1	No	Fillable Fileable
Form and Instruction	2	No	Fillable Fileable
Form and Instruction	3	No	Fillable Fileable
Form and Instruction	4	No	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	24	24
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo		01/16/2024
Instructions for Installing Microsoft Teams		01/16/2024
Participant Recruitment Advertisement Script		01/16/2024
Participant Recruitment Flyer		01/16/2024
Screener Questionnaire for Participant Recruitment		01/16/2024
Round-1 Protocol		01/16/2024
Adult Consent Form		01/16/2024
Consent Form for Minors		01/16/2024
Demographic Questionnaire		01/16/2024
Satisfaction Questionnaire		01/16/2024
Incentive Voucher		01/16/2024
Food-at-Home (FAH) Use Case		01/16/2024
Food-away-from-Home (FAFH) Use Case		01/16/2024
School-Meal Use Cases		01/16/2024
Critical Tasks		01/16/2024
Round-2&3 Protocol		01/16/2024
Quiz for Training Assessment		01/16/2024

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

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