OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Pretests for an alternate data collection method (ADCM) for FoodAPS2

IC 221075 under ICR 201511-0536-001 · OMB 0536-0073.

Documents and Forms
Document Name
Document Type
Other-Screening questions
Other-Web-based Food reporting syste
Other-Income Worksheet web instrumen
Other-Meal and Snake Form
Other-Final Interview Income Questio
Other-Screener for Pretest 2
Other-Initial Interview_Pretest 2
Other-Final Interview_Pretest 2
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Pretests for an alternate data collection method (ADCM) for FoodAPS2
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screening questions Pretest_generic_clearance_Appendix B_Recruitment Script.docx Yes Yes Fillable Printable
Other-Web-based Food reporting system Pretest_generic_clearance_Appendix C-1_Web-based FARS Screenshots.docx Yes Yes Fillable Fileable
Other-Income Worksheet web instrument Pretest_generic_clearance_Appendix C-2_Income Worksheet.docx Yes Yes Fillable Fileable
Other-Meal and Snake Form Pretest_generic_clearance_Appendix C-3_Meals and Snacks Form.docx Yes Yes Fillable Fileable
Other-Final Interview Income Questions Pretest_generic_clearance_Appendix C-4_Final Interview Income Questions.docx Yes Yes Fillable Fileable
Other-Screener for Pretest 2 Pretest_generic_clearance_Appendix C-5_Screener_Pretest 2_04112016_final.docx Yes Yes Fillable Fileable
Other-Initial Interview_Pretest 2 Pretest_generic_clearance_Appendix C-6_Initial Interview_Pretest 2.docx Yes Yes Fillable Fileable
Other-Final Interview_Pretest 2 Pretest_generic_clearance_Appendix C-7_Final Interview_Pretest 2_04122016_final.docx Yes Yes Fillable Fileable

Income Security Food and Nutrition Assistance

 

50 0
   
Individuals or Households
 
   100 %

  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 50 0 50 0 0 0
Annual IC Time Burden (Hours) 263 0 263 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix A_Recruitment Ad Pretest_generic_clearance_Appendix A_Recruitment Ad.docx 04/14/2016
Appendix D-2-Minor Assent for Pretest 1&2 Pretest_generic_clearance_Appendix D-2-Minor Assent for Pretest 1&2_04122016_final.docx 04/14/2016
Appendix E-Pretest 1 Debriefing Protocol Pretest_generic_clearance_Appendix E-Pretest 1 Debriefing Protocol.docx 04/14/2016
Appendix F-Feedback Form_Pretest 2 Pretest_generic_clearance_Appendix F-Feedback Form_Pretest 2.docx 04/14/2016
Appendix H_Study Fact Sheet Pretest_generic_clearance_Appendix H_Study Fact Sheet.docx 04/14/2016
Study Requesting Memo Pretest_generic_clearance 04222016-Rev.docx 04/25/2016
Appendix D-1-Consent Form_Pretest 1 Pretest_generic_clearance_Appendix D-1-Consent Form_Pretest 1 _04222016_rev.docx 04/25/2016
Appendix D-3-Consent Form_Pretest 2 Pretest_generic_clearance_Appendix D-3-Consent Form_Pretest 2_04222016_rev.docx 04/25/2016
Appendix G-1_Disclaimer for Pretest 1 Pretest_generic_clearance_Appendix G-1_Disclaimer for Pretest 1_PW.docx 04/25/2016
Appendix G-2_Disclaimer_Pretest 2 Pretest_generic_clearance_Appendix G-2_Disclaimer_Pretest 2_PW.docx 04/25/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.