State, Local and Tribal Agencies (Respondents)

Assessment of States’ Use of Computer Matching Protocols in SNAP

Documents and Forms

Document Name Document Type
Attachment C.1. National Survey of State SNAP Data Matching, State-Level Survey.docx www.qualtrics.com Other-Attachment C.1. National Surve
Attachment C.2 National Survey of State SNAP Data Matching, County-Level Survey.docx www.qualtrics.com Other-Attachment C.2 National Survey
Attachment D. Screen Shot of Web Survey.docx www.qualtrics.com Other-Attachment D. Screen Shot of W
Attachment E. Introduction letter to regional directors of upcoming study.docx Attachment E. Introduction letter to regional directors of upcoming study.docx IC Document
Attachment G. Introduction letter to State SNAP directors of upcoming study.docx Attachment G. Introduction letter to State SNAP directors of upcoming study.docx IC Document
Attachment I. Letter to State administrative staff to participate in survey.docx Attachment I. Letter to State administrative staff to participate in survey.docx IC Document
Attachment M. Follow-up Email.docx Attachment M. Follow-up Email.docx IC Document
Attachment N. Follow-up Telephone Script.docx Attachment N. Follow-up Telephone Script.docx IC Document

Information Collection (IC) Details

IC Title:	State, Local and Tribal Agencies (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	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment C.1. National Survey of State SNAP Data Matching, State-Level Survey.docx	Attachment C.1. National Survey of State SNAP Data Matching, State-Level Survey.docx	www.qualtrics.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment C.2 National Survey of State SNAP Data Matching, County-Level Survey.docx	Attachment C.2 National Survey of State SNAP Data Matching, County-Level Survey.docx	www.qualtrics.com	Yes	Yes	Fillable Fileable Signable
Other-Attachment D. Screen Shot of Web Survey.docx	Attachment D. Screen Shot of Web Survey.docx	www.qualtrics.com	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 221	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	221	221
Annual IC Time Burden (Hours)	181	181
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment E. Introduction letter to regional directors of upcoming study.docx	Attachment E. Introduction letter to regional directors of upcoming study.docx	08/29/2017
Attachment G. Introduction letter to State SNAP directors of upcoming study.docx	Attachment G. Introduction letter to State SNAP directors of upcoming study.docx	08/29/2017
Attachment I. Letter to State administrative staff to participate in survey.docx	Attachment I. Letter to State administrative staff to participate in survey.docx	08/29/2017
Attachment M. Follow-up Email.docx	Attachment M. Follow-up Email.docx	08/29/2017
Attachment N. Follow-up Telephone Script.docx	Attachment N. Follow-up Telephone Script.docx	08/29/2017

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