NSLP Verification II - SLT IC (IC 1 of 2)

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Overview

Dates_And_Responses
Sheet2

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Sheet 1: Dates_And_Responses

	Attachment F - Report Template (example only) for HH Contact & Responses						OMB Number: 0584-0524 Expiration Date: 06/30/2016
Household		Notices		Reminders			Response
Household (non-PII) Identifier	Group (Intervention / Control)	Certification Notice	Verification Notice	Reminder #1	Reminder #2	Reminder #3	Response	Response Type
1	Intervention	8/12/2016	8/12/2016	8/26/2016			8/28/2016	3. email	EXAMPLE
2
3
…
N
* As noted in the project documentation, the pilot will aim to collect this data automatically through the software that is already in place.
An Affirmative Action/Equal Opportunity Employer According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time required to complete this information collection is estimated to average about 45 minutes (0.75 hours) in one-time activity, and 3 minutes (0.05 hours) per variable response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

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Sheet 2: Sheet2

Group	Response_Type
Intervention	1. online
Control	2. postal_mail
	3. email
	4. fax
	5. in-person
	6. other