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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Individuals/Households - Households
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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-B6a. (Instrument E7) Household Survey Income Worksheet_v4_English
B6a. (Instrument E7) Household Survey Income Worksheet_v4_English.docx
Yes
Yes
Fillable Fileable
Other-B6b. (Instrument E7) Household Income Worksheet_Spanish
B6b. (Instrument E7) Household Income Worksheet_Spanish.docx
Yes
Yes
Fillable Fileable
Other-B7a. (Instrument E10) Instructions for Inc Documentation After Survey_v6_English
B7a. (Instrument E10) Instructions for Inc Documentation After Survey_v6_English.docx
Yes
Yes
Fillable Fileable
Other-B7b. (Instrument E10) Instructions for Inc Documentation_Spanish
B7b. (Instrument E10) Instructions for Inc Documentation_Spanish.docx
Yes
Yes
Fillable Fileable
Other-Appendix B5a. Household Survey (English)
Appendix B5a. Household Survey (English).docx
No
Paper Only
Other-Appendix B5b. Household Survey (Spanish)
Appendix B5b. Household Survey (Spanish).docx
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:
FNS-8 USDA/FNS Studies and Reports
FR Citation:
56 FR 19078
Number of Respondents:
8,801
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
75,951
0
0
0
0
75,951
Annual IC Time Burden (Hours)
15,385
0
0
0
0
15,385
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
C16a. (Recruitment 018) Household Survey Brochure v3_English
C16a. (Recruitment 018) Household Survey Brochure v3_English.pdf
02/09/2022
C16b. (Recruitment 018) Household Survey Brochure_Spanish
C16b. (Recruitment 018) Household Survey Brochure_Spanish.pdf
02/09/2022
C24a. (Recruitment 020) Household Confirmation and Reminder of Virtual Survey_v6_English
C24a. (Recruitment 020) Household Confirmation and Reminder of Virtual Survey_v6_English.docx
02/09/2022
C24b. (Recruitment 020). Household Confirmation and Reminder of Virtual Survey_Spanish
C24b. (Recruitment 020). Household Confirmation and Reminder of Virtual Survey_Spanish.docx
02/09/2022
C25a. (Recruitment 025) Household Consent form_Virtual Survey_v3_English
C25a. (Recruitment 025) Household Consent form_Virtual Survey_v3_English.docx
02/09/2022
C25b. (Recruitment 025) Household Consent form_Virtual Survey_Spanish
C25b. (Recruitment 025) Household Consent form_Virtual Survey_Spanish.docx
02/09/2022
C26a. (Recruitment 021) Household Survey Recruitment Guide-In person survey_v5_English
C26a. (Recruitment 021) Household Survey Recruitment Guide-In person survey_v5_English.docx
02/09/2022
C26b. (Recruitment 021). Household Survey Recruitment Guide-In person_SPAN
C26b. (Recruitment 021). Household Survey Recruitment Guide-In person_SPAN.docx
02/09/2022
C27a. (Recruitment 022) Household Fact Sheet Re In-Person Survey_v3_English
C27a. (Recruitment 022) Household Fact Sheet Re In-Person Survey_v3_English.docx
02/09/2022
C27b. (Recruitment 022). Household Fact Sheet Re In-Person Survey_SPAN
C27b. (Recruitment 022). Household Fact Sheet Re In-Person Survey_SPAN.docx
02/09/2022
C28a. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_v4_English
C28a. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_v4_English.docx
02/09/2022
C28b. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_SPAN
C28b. (Recruitment 023) Household Confirmation and Reminder of In Person Survey_SPAN.docx
02/09/2022
C29. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7
C29. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7.docx
02/09/2022
C26. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7
C26. (Recruitment 100) Recruitment 100_APEC IV_Study Website Crosswalk_v7.docx
05/18/2022
Appendix C22a. Household Survey Recruitment Letter (English)
Appendix C22a. Household Survey Recruitment Letter (English).docx
08/16/2022
Appendix C22b. Household Survey Recruitment Letter (Spanish)
Appendix C22b. Household Survey Recruitment Letter (Spanish).docx
08/16/2022
Appendix C23a. Household Survey Recruitment Guide (English)
Appendix C23a. Household Survey Recruitment Guide (English).docx
08/16/2022
Appendix C23b. Household Survey Recruitment Guide (Spanish)
Appendix C23b. Household Survey Recruitment Guide (Spanish).docx
08/16/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.