Information Collection

Evaluation of FY 2019 Summer Electronic Benefit Transfer (EBT) Demonstrations - Retailers (3 of 3)

IC 242302 under ICR 202105-0584-004 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Document Name Document Type
Attachment H Retailer Interview Protocol.docx Other-Attachment H Retailer Intervie
Attachment H Retailer Interview Protocol.docx Other-Attachment H Retailer Intervie
Attachment I.1 Grantee Introductory Email to Retailers.docx Attachment I.1 Grantee Introductory Email to Retailers IC Document
Attachment I.1 Grantee Introductory Email to Retailers.docx Attachment I.1 Grantee Introductory Email to Retailers IC Document
Attachment I.2 Study Team Introductory Email to Retailers.docx Attachment I.2 Study Team Introductory Email to Retailers IC Document
Attachment I.2 Study Team Introductory Email to Retailers.docx Attachment I.2 Study Team Introductory Email to Retailers IC Document
Attachment I.3 Telephone Script for Retailer Recruitment.docx Attachment I.3 Telephone Script for Retailer Recruitment IC Document
Attachment I.3 Telephone Script for Retailer Recruitment.docx Attachment I.3 Telephone Script for Retailer Recruitment IC Document
Attachment I.4 Interview Confirmation Email Template for Retailers.docx Attachment I.4 Interview Confirmation Email Template for Retailers IC Document
Attachment I.4 Interview Confirmation Email Template for Retailers.docx Attachment I.4 Interview Confirmation Email Template for Retailers IC Document
Attachment A Burden table 6.17.20.xlsx Attachment A Burden Table IC Document
Attachment A Burden table 6.17.20.xlsx Attachment A Burden Table IC Document
Attachment J IRB Approval.pdf Attachment J IRB Approval IC Document
Attachment J IRB Approval.pdf Attachment J IRB Approval IC Document
2019 Summer EBT Generic Submission 25 Jun 2020 Memo.docx 2019 Summer EBT Generic Submission 25 Jun 2020 Memo IC Document
2019 Summer EBT Generic Submission 25 Jun 2020 Memo.docx 2019 Summer EBT Generic Submission 25 Jun 2020 Memo IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation of FY 2019 Summer Electronic Benefit Transfer (EBT) Demonstrations - Retailers (3 of 3)	Agency IC Tracking Number:

IC Status: Unchanged

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-Attachment H Retailer Interview Protocol			Attachment H Retailer Interview Protocol.docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title: FNS-8 FNS Studies and Reports	FR Citation: 56 FR 19078

Number of Respondents: 32	Number of Respondents for Small Entity: 20

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	102	102
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment I.1 Grantee Introductory Email to Retailers	Attachment I.1 Grantee Introductory Email to Retailers.docx	06/18/2020
Attachment I.2 Study Team Introductory Email to Retailers	Attachment I.2 Study Team Introductory Email to Retailers.docx	06/18/2020
Attachment I.3 Telephone Script for Retailer Recruitment	Attachment I.3 Telephone Script for Retailer Recruitment.docx	06/18/2020
Attachment I.4 Interview Confirmation Email Template for Retailers	Attachment I.4 Interview Confirmation Email Template for Retailers.docx	06/18/2020
Attachment A Burden Table	Attachment A Burden table 6.17.20.xlsx	06/18/2020
Attachment J IRB Approval	Attachment J IRB Approval.pdf	06/18/2020
2019 Summer EBT Generic Submission 25 Jun 2020 Memo	2019 Summer EBT Generic Submission 25 Jun 2020 Memo.docx	06/26/2020

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