Information Collection

FoodAPS Field Test - Respondents

IC 251684 under ICR 202202-0536-002 · OMB 0536-0077.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0536-0077 can be found here:

2022-06-10 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Attachment B - Recruitment screener 01252022.docx Other-Attachment B - Recruitment scr
Attachment B - Recruitment screener 01252022.docx Other-Attachment B - Recruitment scr
Attachment B1 - Screenshots of Mail Household Screener (Web Version) 01042022.docx Other-Attachment B1 - Screenshots of
Attachment B1 - Screenshots of Mail Household Screener (Web Version) 01042022.docx Other-Attachment B1 - Screenshots of
Attachment J - Profile Questionnaire 02152022.docx Other-Attachment J - Profile Questio
Attachment J - Profile Questionnaire 02152022.docx Other-Attachment J - Profile Questio
Attachment J1 - Screenshots of FoodLogger Version of Profile Questionnaire 01042022.docx Other-Attachment J1 - Screenshots of
Attachment J1 - Screenshots of FoodLogger Version of Profile Questionnaire 01042022.docx Other-Attachment J1 - Screenshots of
Attachment J2 - Web Screenshots for Profile Questionnaire 01042022.docx Other-Attachment J2 - Web Screenshot
Attachment J2 - Web Screenshots for Profile Questionnaire 01042022.docx Other-Attachment J2 - Web Screenshot
Attachment L - Income Questionnaire 01042022.docx Other-Attachment L - Income Question
Attachment L - Income Questionnaire 01042022.docx Other-Attachment L - Income Question
Attachment L1 - Screenshots of FoodLogger Version of Income Questionnaire 01042022.docx Other-Attachment L1 - Screenshots of
Attachment L1 - Screenshots of FoodLogger Version of Income Questionnaire 01042022.docx Other-Attachment L1 - Screenshots of
Attachment L2 - Web Screenshots of Income Questionnaire 01042022.docx Other-Attachment L2 - Web Screenshot
Attachment L2 - Web Screenshots of Income Questionnaire 01042022.docx Other-Attachment L2 - Web Screenshot
Attachment M - Memory Jogger 10292021.docx Other-Attachment M - Memory Jogger
Attachment M - Memory Jogger 10292021.docx Other-Attachment M - Memory Jogger
Attachment O - Debriefing Interview 07272021.docx Other-Attachment O - Debriefing Inte
Attachment O - Debriefing Interview 07272021.docx Other-Attachment O - Debriefing Inte
Attachment R1 - Food Log Questionnaire_GoldStand 01042022.docx Other-Attachment R1 - Food Log Quest
Attachment R1 - Food Log Questionnaire_GoldStand 01042022.docx Other-Attachment R1 - Food Log Quest
Attachment R2 - Screenshots of FoodLogger Version of Food Log 01042022.docx Other-Attachment R2 - Screenshots of
Attachment R2 - Screenshots of FoodLogger Version of Food Log 01042022.docx Other-Attachment R2 - Screenshots of
Attachment R3 - Web Screenshots of Food Log 01042022.docx Other-Attachment R3 - Web Screenshot
Attachment R3 - Web Screenshots of Food Log 01042022.docx Other-Attachment R3 - Web Screenshot
Attachment C1 - Introductory letter 01252022.docx Attachment C1 - Introductory letter IC Document
Attachment C1 - Introductory letter 01252022.docx Attachment C1 - Introductory letter IC Document
Attachment D1 - In-person Screening Advance Letter 02152022.docx Attachment D1 - In-person Screening Advance Letter IC Document
Attachment D1 - In-person Screening Advance Letter 02152022.docx Attachment D1 - In-person Screening Advance Letter IC Document
Attachment D2 - Interviewer Authorization Letter 07272021.docx Attachment D2 - Interviewer Authorization Letter IC Document
Attachment D2 - Interviewer Authorization Letter 07272021.docx Attachment D2 - Interviewer Authorization Letter IC Document
Attachment D3 - Gated Community Letter 07272021.docx Attachment D3 - Gated Community Letter IC Document
Attachment D3 - Gated Community Letter 07272021.docx Attachment D3 - Gated Community Letter IC Document
Attachment D5 - Frequently Asked Questions and Responses 02152022.docx Attachment D5 - Frequently Asked Questions and Responses IC Document
Attachment D5 - Frequently Asked Questions and Responses 02152022.docx Attachment D5 - Frequently Asked Questions and Responses IC Document
Attachment E - In-person Household Screener 09082021.docx Attachment E - In-person Household Screener IC Document
Attachment E - In-person Household Screener 09082021.docx Attachment E - In-person Household Screener IC Document
Attachment F1 - Household Consent Form 01042022.docx Attachment F1 - Household Consent Form IC Document
Attachment F1 - Household Consent Form 01042022.docx Attachment F1 - Household Consent Form IC Document
Attachment F2 - Parental Consent Form 01042022.docx Attachment F2 - Parental Consent Form IC Document
Attachment F2 - Parental Consent Form 01042022.docx Attachment F2 - Parental Consent Form IC Document
Attachment F3 - Individual Assent Consent Form 01252022.docx Attachment F3 - Individual Assent Consent Form IC Document
Attachment F3 - Individual Assent Consent Form 01252022.docx Attachment F3 - Individual Assent Consent Form IC Document
Attachment G - Initial Household Interview 02152022.docx Attachment G - Initial Household Interview IC Document
Attachment G - Initial Household Interview 02152022.docx Attachment G - Initial Household Interview IC Document
Attachment H1 - NFS Field Test Overview (Interviewer Training Manual) 09082021.docx Attachment H1 - NFS Field Test Overview (Interviewer Training Manual) IC Document
Attachment H1 - NFS Field Test Overview (Interviewer Training Manual) 09082021.docx Attachment H1 - NFS Field Test Overview (Interviewer Training Manual) IC Document
Attachment H2 - Contacting Procedures (Interviewer Training Manual) 10292021.docx Attachment H2 - Contacting Procedures (Interviewer Training Manual) IC Document
Attachment H2 - Contacting Procedures (Interviewer Training Manual) 10292021.docx Attachment H2 - Contacting Procedures (Interviewer Training Manual) IC Document
Attachment H3 - Data Collection (Interviewer Training Manual) 11172021.docx Attachment H3 - Data Collection (Interviewer Training Manual) IC Document
Attachment H3 - Data Collection (Interviewer Training Manual) 11172021.docx Attachment H3 - Data Collection (Interviewer Training Manual) IC Document
Attachment H4 - Equipment (Interviewer Training Manual) 09082021.docx Attachment H4 - Equipment (Interviewer Training Manual) IC Document
Attachment H4 - Equipment (Interviewer Training Manual) 09082021.docx Attachment H4 - Equipment (Interviewer Training Manual) IC Document
Attachment H5 - Mobile Device User Guide (Interviewer Training Manual) 09082021.docx Attachment H5 - Mobile Device User Guide (Interviewer Training Manual) IC Document
Attachment H5 - Mobile Device User Guide (Interviewer Training Manual) 09082021.docx Attachment H5 - Mobile Device User Guide (Interviewer Training Manual) IC Document
Attachment H6 - Quality Control (Interviewer Training Manual) 09082021.docx Attachment H6 - Quality Control (Interviewer Training Manual) IC Document
Attachment H6 - Quality Control (Interviewer Training Manual) 09082021.docx Attachment H6 - Quality Control (Interviewer Training Manual) IC Document
Attachment H7 - Report Calls (Interviewer Training Manual) 09082021.docx Attachment H7 - Report Calls (Interviewer Training Manual) IC Document
Attachment H7 - Report Calls (Interviewer Training Manual) 09082021.docx Attachment H7 - Report Calls (Interviewer Training Manual) IC Document
Attachment H8 - Administrative Procedures (Interviewer Training Manual) 09082021.docx Attachment H8 - Administrative Procedures (Interviewer Training Manual) IC Document
Attachment H8 - Administrative Procedures (Interviewer Training Manual) 09082021.docx Attachment H8 - Administrative Procedures (Interviewer Training Manual) IC Document
Attachment I1 - How to Connect a Mi-Fi & Barcode Scanner 10292021.docx Attachment I1 - How to Connect a Mi-Fi & Barcode Scanner IC Document
Attachment I1 - How to Connect a Mi-Fi & Barcode Scanner 10292021.docx Attachment I1 - How to Connect a Mi-Fi & Barcode Scanner IC Document
Attachment I2 - Household Equipment Form 10292021.docx Attachment I2 - Household Equipment Form IC Document
Attachment I2 - Household Equipment Form 10292021.docx Attachment I2 - Household Equipment Form IC Document
Attachment I3 - Downloading and Installing the FoodLogger 10292021.pdf Attachment I3 - Downloading and Installing the FoodLogger IC Document
Attachment I3 - Downloading and Installing the FoodLogger 10292021.pdf Attachment I3 - Downloading and Installing the FoodLogger IC Document
Attachment K - Interviewer Observations 07272021.docx Attachment K - Interviewer Observations IC Document
Attachment K - Interviewer Observations 07272021.docx Attachment K - Interviewer Observations IC Document
Attachment N - Electronic Text and e-mail Communications 02152022.docx Attachment N - Electronic Text and e-mail Communications IC Document
Attachment N - Electronic Text and e-mail Communications 02152022.docx Attachment N - Electronic Text and e-mail Communications IC Document
Attachment Q - What to Report and What Not to Report 10292021.pdf Attachment Q - What to Report and What Not to Report IC Document
Attachment Q - What to Report and What Not to Report 10292021.pdf Attachment Q - What to Report and What Not to Report IC Document
Attachment V1 - Welcome to NFS Video Script 10292021.docx Attachment V1 - Welcome to NFS Video Script IC Document
Attachment V1 - Welcome to NFS Video Script 10292021.docx Attachment V1 - Welcome to NFS Video Script IC Document
Attachment V2 - Getting Started Video Script 10292021.docx Attachment V2 - Getting Started Video Script IC Document
Attachment V2 - Getting Started Video Script 10292021.docx Attachment V2 - Getting Started Video Script IC Document
Attachment V3 - Entering Grocery Store Food and Drink 10292021.docx Attachment V3 - Entering Grocery Store Food and Drink IC Document
Attachment V3 - Entering Grocery Store Food and Drink 10292021.docx Attachment V3 - Entering Grocery Store Food and Drink IC Document
Attachment V4 - Entering Restaurant Food and Drink Video Script 10292021.docx Attachment V4 - Entering Restaurant Food and Drink Video Script IC Document
Attachment V4 - Entering Restaurant Food and Drink Video Script 10292021.docx Attachment V4 - Entering Restaurant Food and Drink Video Script IC Document
Attachment V5 - Completing Profile and Income Questionnaires Video Script 10292021.docx Attachment V5 - Completing Profile and Income Questionnaires Video Script IC Document
Attachment V5 - Completing Profile and Income Questionnaires Video Script 10292021.docx Attachment V5 - Completing Profile and Income Questionnaires Video Script IC Document
Attachment V6 - Completing the Day Overview Video Script 10292021.docx Attachment V6 - Completing the Day Overview Video Script IC Document
Attachment V6 - Completing the Day Overview Video Script 10292021.docx Attachment V6 - Completing the Day Overview Video Script IC Document
Attachment V7 - Grocery Store Purchase Video Script 10292021.docx Attachment V7 - Grocery Store Purchase Video Script IC Document
Attachment V7 - Grocery Store Purchase Video Script 10292021.docx Attachment V7 - Grocery Store Purchase Video Script IC Document
Attachment V8 - How to Report Meals from a Fast Food Restuarant Video Script 10292021.docx Attachment V8 - How to Report Meals from a Fast Food Restuarant Video Script IC Document
Attachment V8 - How to Report Meals from a Fast Food Restuarant Video Script 10292021.docx Attachment V8 - How to Report Meals from a Fast Food Restuarant Video Script IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	FoodAPS Field Test - Respondents	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?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment B - Recruitment screener	Attachment B - Recruitment screener 01252022.docx	Yes	Yes	Fillable Fileable
Other-Attachment B1 - Screenshots of Mail Household Screener (Web Version	Attachment B1 - Screenshots of Mail Household Screener (Web Version) 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment J - Profile Questionnaire	Attachment J - Profile Questionnaire 02152022.docx	Yes	Yes	Fillable Fileable
Other-Attachment J1 - Screenshots of FoodLogger Version of Profile Questionnaire	Attachment J1 - Screenshots of FoodLogger Version of Profile Questionnaire 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment J2 - Web Screenshots for Profile Questionnaire	Attachment J2 - Web Screenshots for Profile Questionnaire 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment L - Income Questionnaire	Attachment L - Income Questionnaire 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment L1 - Screenshots of FoodLogger Version of Income Questionnaire	Attachment L1 - Screenshots of FoodLogger Version of Income Questionnaire 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment L2 - Web Screenshots of Income Questionnaire	Attachment L2 - Web Screenshots of Income Questionnaire 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment M - Memory Jogger	Attachment M - Memory Jogger 10292021.docx	No		Printable Only
Other-Attachment O - Debriefing Interview	Attachment O - Debriefing Interview 07272021.docx	Yes	Yes	Fillable Printable
Other-Attachment R1 - Food Log Questionnaire_GoldStand	Attachment R1 - Food Log Questionnaire_GoldStand 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment R2 - Screenshots of FoodLogger Version of Food Log	Attachment R2 - Screenshots of FoodLogger Version of Food Log 01042022.docx	Yes	Yes	Fillable Fileable
Other-Attachment R3 - Web Screenshots of Food Log	Attachment R3 - Web Screenshots of Food Log 01042022.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 430	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	430	430
Annual IC Time Burden (Hours)	2,718	2,718
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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