Information Collection

Households: M - Household Survey

IC 203796 under ICR 201705-0584-004 · OMB 0584-0530.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0530 can be found here:

Documents and Forms

Document Name Document Type
rev062112 Attachment M.1-Household Survey.doc Other-M.1-Household Survey
rev062112 Attachment M.2-Household_Survey_Spanish.doc Other-M.2-Household_Survey_Spanish
rev062112 Attachment L.1-HH Letter.doc L.1-HH Letter IC Document
rev062112 Attachment L.2-HH Spanish Letter.doc L.2-HH Spanish Letter IC Document
rev062112 Attachment L.3-National School Meals Brochure.doc L.3-National School Meals Brochure IC Document
rev062112 Attachment L.4-National School Meals Brochure_Spanish.doc L.4-National School Meals Brochure_Spanish IC Document
rev062112 Attachment L.5-Informed Consent for Participation.docm L.5-Informed Consent for Participation IC Document
rev062112 Attachment L.6-Informed Consent for Participation_Spanish.docm L.6-Informed Consent for Participation_Spanish IC Document
rev062112 Attachment L.7-Consent for Access to Education Records_CEO.docm L.7-Consent for Access to Education Records_CEO IC Document
rev062112 Attachment L.8-Consent for Access to Education Records_CEO_Spanish.docm L.8-Consent for Access to Education Records_CEO_Spanish IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Households: M - Household Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-M.1-Household Survey			rev062112 Attachment M.1-Household Survey.doc		No		Paper Only
Other-M.2-Household_Survey_Spanish			rev062112 Attachment M.2-Household_Survey_Spanish.doc		No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: FNS Studies and Reports	FR Citation: 56 FR 19078

Number of Respondents: 4,424	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-4,424	4,424
Annual IC Time Burden (Hours)	-3,318	3,318
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
L.1-HH Letter	rev062112 Attachment L.1-HH Letter.doc	08/19/2012
L.2-HH Spanish Letter	rev062112 Attachment L.2-HH Spanish Letter.doc	08/19/2012
L.3-National School Meals Brochure	rev062112 Attachment L.3-National School Meals Brochure.doc	08/19/2012
L.4-National School Meals Brochure_Spanish	rev062112 Attachment L.4-National School Meals Brochure_Spanish.doc	08/19/2012
L.5-Informed Consent for Participation	rev062112 Attachment L.5-Informed Consent for Participation.docm	08/19/2012
L.6-Informed Consent for Participation_Spanish	rev062112 Attachment L.6-Informed Consent for Participation_Spanish.docm	08/19/2012
L.7-Consent for Access to Education Records_CEO	rev062112 Attachment L.7-Consent for Access to Education Records_CEO.docm	08/19/2012
L.8-Consent for Access to Education Records_CEO_Spanish	rev062112 Attachment L.8-Consent for Access to Education Records_CEO_Spanish.docm	08/19/2012

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