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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
CPS Food Security Supplement
Agency IC Tracking Number:
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
Form and Instruction
1
Protocol and Questionnaire
Attachment II CPS_FSS_Protocol_Questionnaire.doc
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Central Records & Statistical Mgt
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
30
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
30
0
30
0
0
0
Annual IC Time Burden (Hours)
50
0
50
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB Memo
CPS FSS OMB Memo.docx
05/14/2019
Recruitment Ads
Attachment I CPS Combo Ad_BOC Email and Craigslist.docx
05/14/2019
Consent Form
Attachment III Consent Form.doc
05/14/2019
Additional Screener Questions
Attachment IV Recruitment Eligibility Screeners.docx
05/14/2019
Recruitment Flier
Attachment V CPS Flyer 2019 flyer.pdf
05/14/2019
Voucher Form
Attachment VI voucherform.doc
05/14/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.