OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Elderly & Working Poor

IC 193210 under ICR 201204-0584-002 · OMB 0584-0558.

Documents and Forms
Document Name
Document Type
Other-Telephone Screener
Other-Telephone Screener
Other-Focus Group Guide
Other-Focus Group Guide - Spanish
Other-Recruitment Script Working Poo
Other-Appendix B: REVISED Screener f
Other-Appendix E: REVISED Focus Grou
Other-REVISE Modification Protocol
Other-Modification_protocol_Washingt
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Elderly & Working Poor
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Telephone Screener Appendix A Screener for Working Poor Final 10-5-2010.docx No   Paper Only
Other-Telephone Screener Appendix_B_Screener_for_Elderly_Fina.docx No   Paper Only
Other-Focus Group Guide Appendix E Focus Group Discussion Protocol Final 10-5-2010.docx No   Paper Only
Other-Focus Group Guide - Spanish Appendix I Focus Group Protocol Spanish Final 10-5-2010.docx No   Paper Only
Other-Recruitment Script Working Poor - Spanish Appendix F Recruitment Script Working Poor Spanish Final 10-5-2010.docx No   Paper Only
Other-Appendix B: REVISED Screener for Elderly Appendix B Screener for Elderly Final.docx No   Paper Only
Other-Appendix E: REVISED Focus Group Discussion Protocol Appendix E Focus Group Discussion Protocol Revised.docx No   Paper Only
Other-REVISE Modification Protocol Modification_protocol (2).docx No   Paper Only
Other-Modification_protocol_WashingtonPRAB recommendations 4-26-2012 Modification_protocol_WashingtonPRAB recommendations 4-26-2012.docx No   Paper Only

Income Security Food and Nutrition Assistance

 

1,200 0
   
Individuals or Households
 
   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 1,200 0 0 0 0 1,200
Annual IC Time Burden (Hours) 195 0 0 0 0 195
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Reminder Telephone Script Appendix C Focus Group Reminder Letter 6-10-10.docx 06/10/2010
Reminder Call - Spanish Appendix D Focus Group Reminder Call.docx 06/09/2010
Reminder Letter - Spanish Appendix G Focus Group Reminder Letter Spanish.docx 06/10/2010
REVISED Reminder Call Script for Elderly Reminder Call Script With Final Comments-pretest_revised.docx 07/13/2011
Reminder Letter reminder letter with final comments-pretest_revised 07/13/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.