Information Collection

Respondents Individuals/Households - Elderly 60+

IC 228206 under ICR 201708-0584-003 · OMB 0584-0637.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0637 can be found here:

Documents and Forms

Document Name Document Type
Attch H.1_Elderly Participant Interview Guide.docx Other-Attachment H.1_Elderly Partici
Attch H.1.a_Elderly Participant Interview Guide_Spanish.docx Other-Attachment H.1.a_Elderly Parti
Attch H.2_Elderly Participant Focus Group Guide.docx Other-Attachment H.2_Elderly Partici
Attch D.5_Interview Screen Form.docx Other-Attch D.5_Interview Screen For
Attch D.5.a Int Screen Form_Spanish 10-16-17.docx Other-Attachment D.5.a Int Screen Fo
Attch D.2_Int Recruitment Flyer 9-13-17.docx Attachment D.2_Int Recruitment Flyer 9-13-17.docx IC Document
Attch D.2.a_Int Flyer_Spanish 9-13-17.docx Attachment D.2.a_Int Flyer_Spanish 9-13-17.docx IC Document
Attch D.3_Recruit Script 10-16-17.docx Attch D.3_Recruit Script 10-16-17.docx IC Document
Attch D.3.a_Recruit Script_Spanish 10-16-17.docx Attch D.3.a_Recruit Script_Spanish 10-16-17.docx IC Document
Attch D.4_Focus Recruitment Flyer 9-13-17.docx Attachment D.4_Focus Recruitment Flyer 9-13-17.docx IC Document
Attch D.6_Interview Consent Form 9-13-17.docx Attachment D.6_Interview Consent Form 9-13-17.docx IC Document
Attch D.6a_Int Consent Form_Spanish 9-13-17.docx Attachment D.6a_Int Consent Form_Spanish 9-13-17.docx IC Document
Attch D.7_Focus Consent Form.docx Attachment D.7_Focus Consent Form.docx IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Respondents Individuals/Households - Elderly 60+	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Attachment H.1_Elderly Participant Interview Guide.docx	Attch H.1_Elderly Participant Interview Guide.docx	No	Paper Only
Other-Attachment H.1.a_Elderly Participant Interview Guide_Spanish.docx	Attch H.1.a_Elderly Participant Interview Guide_Spanish.docx	No	Paper Only
Other-Attachment H.2_Elderly Participant Focus Group Guide.docx	Attch H.2_Elderly Participant Focus Group Guide.docx	No	Paper Only
Other-Attch D.5_Interview Screen Form 10-16-17.docx	Attch D.5_Interview Screen Form.docx	No	Paper Only
Other-Attachment D.5.a Int Screen Form_Spanish.docx	Attch D.5.a Int Screen Form_Spanish 10-16-17.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: FNS-9 STARS	FR Citation: 75 FR 81207

Number of Respondents: 366	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	566	566
Annual IC Time Burden (Hours)	395	395
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment D.2_Int Recruitment Flyer 9-13-17.docx	Attch D.2_Int Recruitment Flyer 9-13-17.docx	09/28/2017
Attachment D.2.a_Int Flyer_Spanish 9-13-17.docx	Attch D.2.a_Int Flyer_Spanish 9-13-17.docx	09/28/2017
Attch D.3_Recruit Script 10-16-17.docx	Attch D.3_Recruit Script 10-16-17.docx	10/16/2017
Attch D.3.a_Recruit Script_Spanish 10-16-17.docx	Attch D.3.a_Recruit Script_Spanish 10-16-17.docx	10/16/2017
Attachment D.4_Focus Recruitment Flyer 9-13-17.docx	Attch D.4_Focus Recruitment Flyer 9-13-17.docx	09/28/2017
Attachment D.6_Interview Consent Form 9-13-17.docx	Attch D.6_Interview Consent Form 9-13-17.docx	09/28/2017
Attachment D.6a_Int Consent Form_Spanish 9-13-17.docx	Attch D.6a_Int Consent Form_Spanish 9-13-17.docx	09/28/2017
Attachment D.7_Focus Consent Form.docx	Attch D.7_Focus Consent Form.docx	09/28/2017

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