View Information Collection (IC)

View Information Collection (IC)

IC Title:	Addendum to 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	Updated Screener	Appendix D Screener Questionnaire for Participant Recruitment revision 20240226.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: 1	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	1	0	1	0	0	0
Annual IC Time Burden (Hours)	0	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Addendum OMB Memo	Addendum to FoodAPS OMB request 20240226.docx	02/26/2024
Originial OMB Memo request	OMB request for FoodAPS-2 Pilot Test usability evaluation revision 20240212.docx	02/26/2024
Consent Form Updated	Appendix F Adult Consent Form_tracked_20240226.docx	02/26/2024

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