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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
FoodAPS Field Test - Respondents
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-Attachment B - Recruitment screener
Attachment B - Recruitment screener 01252022.docx
Yes
Yes
Fillable Fileable
Other-Attachment B1 - Screenshots of Mail Household Screener (Web Version
Attachment B1 - Screenshots of Mail Household Screener (Web Version) 01042022.docx
Yes
Yes
Fillable Fileable
Other-Attachment J - Profile Questionnaire
Attachment J - Profile Questionnaire 02152022.docx
Yes
Yes
Fillable Fileable
Other-Attachment J1 - Screenshots of FoodLogger Version of Profile Questionnaire
Attachment J1 - Screenshots of FoodLogger Version of Profile Questionnaire 01042022.docx
Yes
Yes
Fillable Fileable
Other-Attachment J2 - Web Screenshots for Profile Questionnaire
Attachment J2 - Web Screenshots for Profile Questionnaire 01042022.docx
Yes
Yes
Fillable Fileable
Other-Attachment L - Income Questionnaire
Attachment L - Income Questionnaire 01042022.docx
Yes
Yes
Fillable Fileable
Other-Attachment L1 - Screenshots of FoodLogger Version of Income Questionnaire
Attachment L1 - Screenshots of FoodLogger Version of Income Questionnaire 01042022.docx
Yes
Yes
Fillable Fileable
Other-Attachment L2 - Web Screenshots of Income Questionnaire
Attachment L2 - Web Screenshots of Income Questionnaire 01042022.docx
Yes
Yes
Fillable Fileable
Other-Attachment M - Memory Jogger
Attachment M - Memory Jogger 10292021.docx
No
Printable Only
Other-Attachment O - Debriefing Interview
Attachment O - Debriefing Interview 07272021.docx
Yes
Yes
Fillable Printable
Other-Attachment R1 - Food Log Questionnaire_GoldStand
Attachment R1 - Food Log Questionnaire_GoldStand 01042022.docx
Yes
Yes
Fillable Fileable
Other-Attachment R2 - Screenshots of FoodLogger Version of Food Log
Attachment R2 - Screenshots of FoodLogger Version of Food Log 01042022.docx
Yes
Yes
Fillable Fileable
Other-Attachment R3 - Web Screenshots of Food Log
Attachment R3 - Web Screenshots of Food Log 01042022.docx
Yes
Yes
Fillable Fileable
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:
430
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
430
0
430
0
0
0
Annual IC Time Burden (Hours)
2,718
0
2,718
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment C1 - Introductory letter
Attachment C1 - Introductory letter 01252022.docx
02/18/2022
Attachment D1 - In-person Screening Advance Letter
Attachment D1 - In-person Screening Advance Letter 02152022.docx
02/18/2022
Attachment D2 - Interviewer Authorization Letter
Attachment D2 - Interviewer Authorization Letter 07272021.docx
02/18/2022
Attachment D3 - Gated Community Letter
Attachment D3 - Gated Community Letter 07272021.docx
02/18/2022
Attachment D5 - Frequently Asked Questions and Responses
Attachment D5 - Frequently Asked Questions and Responses 02152022.docx
02/18/2022
Attachment E - In-person Household Screener
Attachment E - In-person Household Screener 09082021.docx
02/18/2022
Attachment F1 - Household Consent Form
Attachment F1 - Household Consent Form 01042022.docx
02/18/2022
Attachment F2 - Parental Consent Form
Attachment F2 - Parental Consent Form 01042022.docx
02/18/2022
Attachment F3 - Individual Assent Consent Form
Attachment F3 - Individual Assent Consent Form 01252022.docx
02/18/2022
Attachment G - Initial Household Interview
Attachment G - Initial Household Interview 02152022.docx
02/18/2022
Attachment H1 - NFS Field Test Overview (Interviewer Training Manual)
Attachment H1 - NFS Field Test Overview (Interviewer Training Manual) 09082021.docx
02/18/2022
Attachment H2 - Contacting Procedures (Interviewer Training Manual)
Attachment H2 - Contacting Procedures (Interviewer Training Manual) 10292021.docx
02/18/2022
Attachment H3 - Data Collection (Interviewer Training Manual)
Attachment H3 - Data Collection (Interviewer Training Manual) 11172021.docx
02/18/2022
Attachment H4 - Equipment (Interviewer Training Manual)
Attachment H4 - Equipment (Interviewer Training Manual) 09082021.docx
02/18/2022
Attachment H5 - Mobile Device User Guide (Interviewer Training Manual)
Attachment H5 - Mobile Device User Guide (Interviewer Training Manual) 09082021.docx
02/18/2022
Attachment H6 - Quality Control (Interviewer Training Manual)
Attachment H6 - Quality Control (Interviewer Training Manual) 09082021.docx
02/18/2022
Attachment H7 - Report Calls (Interviewer Training Manual)
Attachment H7 - Report Calls (Interviewer Training Manual) 09082021.docx
02/18/2022
Attachment H8 - Administrative Procedures (Interviewer Training Manual)
Attachment H8 - Administrative Procedures (Interviewer Training Manual) 09082021.docx
02/18/2022
Attachment I1 - How to Connect a Mi-Fi & Barcode Scanner
Attachment I1 - How to Connect a Mi-Fi & Barcode Scanner 10292021.docx
02/18/2022
Attachment I2 - Household Equipment Form
Attachment I2 - Household Equipment Form 10292021.docx
02/18/2022
Attachment I3 - Downloading and Installing the FoodLogger
Attachment I3 - Downloading and Installing the FoodLogger 10292021.pdf
02/18/2022
Attachment K - Interviewer Observations
Attachment K - Interviewer Observations 07272021.docx
02/18/2022
Attachment N - Electronic Text and e-mail Communications
Attachment N - Electronic Text and e-mail Communications 02152022.docx
02/18/2022
Attachment Q - What to Report and What Not to Report
Attachment Q - What to Report and What Not to Report 10292021.pdf
02/18/2022
Attachment V1 - Welcome to NFS Video Script
Attachment V1 - Welcome to NFS Video Script 10292021.docx
02/18/2022
Attachment V2 - Getting Started Video Script
Attachment V2 - Getting Started Video Script 10292021.docx
02/18/2022
Attachment V3 - Entering Grocery Store Food and Drink
Attachment V3 - Entering Grocery Store Food and Drink 10292021.docx
02/18/2022
Attachment V4 - Entering Restaurant Food and Drink Video Script
Attachment V4 - Entering Restaurant Food and Drink Video Script 10292021.docx
02/18/2022
Attachment V5 - Completing Profile and Income Questionnaires Video Script
Attachment V5 - Completing Profile and Income Questionnaires Video Script 10292021.docx
02/18/2022
Attachment V6 - Completing the Day Overview Video Script
Attachment V6 - Completing the Day Overview Video Script 10292021.docx
02/18/2022
Attachment V7 - Grocery Store Purchase Video Script
Attachment V7 - Grocery Store Purchase Video Script 10292021.docx
02/18/2022
Attachment V8 - How to Report Meals from a Fast Food Restuarant Video Script
Attachment V8 - How to Report Meals from a Fast Food Restuarant Video Script 10292021.docx
02/18/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.