Information Collection

State Agency

IC 218671 under ICR 201510-0584-004 · OMB 0584-0604.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0604 can be found here:

Documents and Forms

Document Name Document Type
H_Master Site Visit Protocol.docx Other-H_Master Site Visit Protocol
I.2_Interview Guide for Providers.docx Other-I.2_Interview Guide for Provid
J.3_Focus Group Moderator Guide for Employers.docx Other-J.3_Focus Group Moderator Guid
M.3_Participant Information Survey - Employer.docx Other-M.3_Participant Information Su
V.1_Time Use Survey.docx Other-V.1_Time Use Survey
V.2_Time-Use Survey_ScreenShots.docx www.notyetcreated.com Other-V.2_Time-Use Survey_ScreenShot
T_SNAPET_dataitems_FINAL.docx T_SNAPET_admindataitems_FINAL IC Document
U_Master Pilot Costs Workbook.xlsx U_Master Pilot Costs Workbook IC Document
I.3_Observation Guide.docx I.3_Observation Guide IC Document
L.3_Focus Group Recruitment Email - Employer.docx L.3_Focus Group Recruitment Email - Employer IC Document
L.4_Focus Group Confirmation Letter - Employer.docx L.4_Focus Group Confirmation Letter - Employer IC Document
W.1_Time Use Survey Initial Email.docx W.1_Time Use Survey Initial Email IC Document
W.2_Time Use Survey Reminder Email.docx W.2_Time Use Survey Reminder Email IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Agency	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-H_Master Site Visit Protocol	H_Master Site Visit Protocol.docx		No		Paper Only
Other-I.2_Interview Guide for Providers	I.2_Interview Guide for Providers.docx		No		Paper Only
Other-M.3_Participant Information Survey - Employer	M.3_Participant Information Survey - Employer.docx		No		Paper Only
Other-V.1_Time Use Survey	V.1_Time Use Survey.docx		No		Paper Only
Other-V.2_Time-Use Survey_ScreenShots	V.2_Time-Use Survey_ScreenShots.docx	www.notyetcreated.com	Yes	Yes	Fillable Fileable Signable
Other-J.3_Focus Group Moderator Guide for Employers	J.3_Focus Group Moderator Guide for Employers.docx		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: USDA/FNS-10 Persons Doing Business with the Food and Nutrition Service,	FR Citation: 65 FR 17252

Number of Respondents: 190	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,100	1,100
Annual IC Time Burden (Hours)	1,585	1,585
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
T_SNAPET_admindataitems_FINAL	T_SNAPET_dataitems_FINAL.docx	10/22/2015
U_Master Pilot Costs Workbook	U_Master Pilot Costs Workbook.xlsx	10/22/2015
I.3_Observation Guide	I.3_Observation Guide.docx	10/23/2015
L.3_Focus Group Recruitment Email - Employer	L.3_Focus Group Recruitment Email - Employer.docx	11/09/2015
L.4_Focus Group Confirmation Letter - Employer	L.4_Focus Group Confirmation Letter - Employer.docx	11/09/2015
W.1_Time Use Survey Initial Email	W.1_Time Use Survey Initial Email.docx	11/09/2015
W.2_Time Use Survey Reminder Email	W.2_Time Use Survey Reminder Email.docx	11/09/2015

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