Note: This survey incorporates branching logic where differing section introductions and questions will be displayed depending upon whether the respondent is from a State- or County- Administered SNAP agency. In those instances of branching, the section introduction or question for State-Administered SNAP agencies appears first while the corresponding version for County-Administered SNAP agencies follows. The same question will be displayed for both agency types unless specifically identified as a “State-Administered Screenshot” or “County-Administered Screenshot”.
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-XXXX. The time required to complete this information collection is estimated to average 60 minutes per 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.
State-Administered Screenshot
County-Administered Screenshot
County-Administered Only Screenshot
(this question will not be asked of State-Administered agencies)
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
Note: The screenshots below illustrate how the text box will appear after a respondent makes a selection.
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
State-Administered Screenshot
County-Administered Screenshot
OMB Number:
0584-#### 1231981BF0081
| Appendix B-
Expiration Date: ##/##/####
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | SNAP PII: Office of Management and Budget Information Collection Review Package |
Subject | 1231981BF0081 |
Author | Andrés Romualdo, MA |
File Modified | 0000-00-00 |
File Created | 2021-02-06 |