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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Usability and Cognitive Evaluation for the Data Collection Instrument of FoodAPS-2 Pilot Study
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
Income and Profile Questionnaire
Appendix Q Income and Profile Questionnaire.docx
No
Fillable Fileable
Form and Instruction
2
Initial Interview
Appendix R Initial Interview.docx
No
Fillable Fileable
Form and Instruction
3
Food Log Questionnaire
Appendix S Food Log Questionnaire.docx
No
Fillable Fileable
Form and Instruction
4
Debriefing Interview
Appendix T Debriefing Interview_clean_01102024.docx
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:
24
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
24
0
24
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
OMB request for FoodAPS-2 Pilot Test usability evaluation.docx
01/16/2024
Instructions for Installing Microsoft Teams
Appendix A Instructions for Installing Microsoft Teams.docx
01/16/2024
Participant Recruitment Advertisement Script
Appendix B Participant Recruitment Advertisement Script_corrected.docx
01/16/2024
Participant Recruitment Flyer
Appendix C Participant Recruitment Flyer_clean_01102024.docx
01/16/2024
Screener Questionnaire for Participant Recruitment
Appendix D Screener Questionnaire for Participant Recruitment_clean_01102024.docx
01/16/2024
Round-1 Protocol
Appendix E Round-1 Protocol_corrected.docx
01/16/2024
Adult Consent Form
Appendix F Adult Consent Form_clean_01102024.docx
01/16/2024
Consent Form for Minors
Appendix G Consent Form for Minors_clean_01102024.docx
01/16/2024
Demographic Questionnaire
Appendix H Demographic Questionnaire.docx
01/16/2024
Satisfaction Questionnaire
Appendix I Satisfaction Questionnaire.docx
01/16/2024
Incentive Voucher
Appendix J Incentive Voucher.docx
01/16/2024
Food-at-Home (FAH) Use Case
Appendix K Food-at-Home (FAH) Use Case.docx
01/16/2024
Food-away-from-Home (FAFH) Use Case
Appendix L Food-away-from-Home (FAFH) Use Case.docx
01/16/2024
School-Meal Use Cases
Appendix M School-Meal Use Cases.docx
01/16/2024
Critical Tasks
Appendix N Critical Tasks.docx
01/16/2024
Round-2&3 Protocol
Appendix O Round-2&3 Protocol_corrected.docx
01/16/2024
Quiz for Training Assessment
Appendix P Quiz for Training Assessment.docx
01/16/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.