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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
SEBTC - Households
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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-Baseline Questionnaire - English & Spanish
Appendix A English baseline instrument 3 15 Final.doc
No
Paper Only
Other-Appendix A :Spanish baseline instrument
Appendix A Spanish baseline instrument 3 15 11 final.doc
No
Paper Only
Other-Appendix B: English Follow-Up instrument
Appendix B English Follow-Up instrument 3 16 11 Final.doc
No
Paper Only
Other-Appendix B Follow-Up questionnaire SPANISH
Appendix B Follow-Up questionnaire SPANISH (3-16-11) Final.doc
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:
FR Citation:
Number of Respondents:
10,667
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
21,334
0
21,334
0
0
0
Annual IC Time Burden (Hours)
15,167
0
15,167
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Advance Letter Baseline Combined
Advance Letter Baseline Combined_REV Final.doc
03/17/2011
Consent Telephone Script (I/H)
Appendix K Participant Consent Language 2-8-2011.docx
02/08/2011
Advance Letter Baseline Combined_REV(SPANISH) Final.docx
Advance Letter Baseline Combined_REV(SPANISH) Final.docx
03/17/2011
Advance Letter_FollowUp_Control_Eng
Advance Letter_FollowUp_Control_Eng_v1 Final.docx
03/17/2011
Advance Letter_FollowUp_Control_Spanish
Advance Letter_FollowUp_Control_Spanish_v3 Final.docx
03/17/2011
Advance Letter_FollowUp_Treatment_Eng
Advance Letter_FollowUp_Treatment_Eng_v1 Final.docx
03/17/2011
Advance Letter_FollowUp_Treatment_Spanish
Advance Letter_FollowUp_Treatment_Spanish_v3 Final.docx
03/17/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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