State, Local or Tribal

Appendix G

SNAP agency administrative data collection instrument

Evaluation of Child Support Cooperation Requirements in SNAP Administrative Data Collection Instrument

The Evaluation of Child Support Cooperation Requirements in the Supplemental Nutrition Assistance Program (SNAP) is examining the implementation, impacts, costs, and benefits of the child support cooperation requirement in the SNAP. For this study, participating States are requested to provide administrative data needed to address the study’s research questions.

Data request

[FOR STATES THAT FORMERLY HAD OR ARE CONSIDERING HAVING A COOPERATION REQUIREMENT]: Please provide requested SNAP household-level administrative data for [SINGLE MONTH].

[FOR STATES THAT FORMERLY HAD OR CURRENTLY HAVE A COOPERATION REQUIREMENT]: Please [ALSO] provide monthly household-level administrative data for SNAP [AND, IF MEDICAID AND/OR TANF ARE ALSO ADMINISTERED IN AGENCY THAT ADMINISTERS SNAP] from [MONTH, YEAR–MONTH, YEAR, DATE RANGE (DEPENDENT ON THE TIMING OF THE STATE’S IMPLEMENTATION OF THE COOPERATION REQUIREMENT)].

Public Burden Statement

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 35 hours 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reducing this burden to the following address: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 1320 Braddock Place, Alexandria, VA 22314, ATTN: PRA (0584-xxxx) Do not return the completed form to this address.

Table G.1. contains a list of the types of data elements we are requesting, pending their availability. The study team will discuss this data request with you to assess the availability of the administrative data your agency maintains and identify which data elements can be provided.

Table G.1. SNAP [Medicaid, and TANF] administrative data elements requested

Administrative data

SNAP administrative data

SNAP application information

Date of application

Disposition of application

Whether application disqualified due to child support noncooperation

Child support payment or receipt self-reported on application

Zip code

SNAP household information

Number of adults listed on application

Number of children listed on application

Age and gender of each adult listed on application

Age and gender of child listed on application

SNAP benefit and sanction history

Number of sanctions

Reason for sanction

Monthly benefit amount

Child support payments made

Child support payments received

Monthly child support cooperation status (cooperating, noncooperating, and those with good cause exemptions)

Data needed to link records across programs (such as name, date of birth, and Social Security number)

Medicaid administrative data

Medicaid application information

Date of application

Disposition of application

Whether application disqualified due to child support noncooperation

Medicaid coverage and sanction history

Monthly indicator for whether covered by Medicaid

Date of sanction

Reason for sanction

Monthly child support cooperation status (cooperating, noncooperating, and those with good cause exemptions)

Data needed to link records across programs (such as name, date of birth, Social Security number)

TANF administrative data

Application information

Date of application

Disposition of application

Whether application disqualified due to child support noncooperation

TANF benefit and sanction history

Monthly benefit amount

Date of sanction

Reason for sanction

Monthly child support cooperation status (cooperating, noncooperating, and those with good cause exemptions)

Data needed to link records across programs (such as name, date of birth, Social Security number)

Data delivery timeline

Please provide the data file by [date agreed to by agency].

Data delivery and storage

We will provide a secure data transfer site to receive the data file. We can accept data in any standard format. We will store the data in a secure project directory to which only those working with the data will have access.

Privacy Act Statement

Authority: This information is being collected under the authority of Section 9 of the Food and Nutrition Act of 2008, as amended, (7 U.S.C. 2018). Disclosure of the information is voluntary.

Purpose: The information is being collected to evaluate Child Support Cooperation Requirements in United States Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP).

Routine Use: The information may be shared with SNAP contract researchers and USDA SNAP research and administrative staff.

Disclosure: Disclosure of the information is voluntary. If all or any part of the information is not provided, interviews may not be admissible in data sets.

The Systems of Records Notices relevant to this collection are FNS-8 FNS Studies and Reports located at https://www.govinfo.gov/content/pkg/FR-1991-04-25/pdf/FR-1991-04-25.pdf and FNS-10 Persons Doing Business with the Food and Nutrition Service (FNS) located at https://www.federalregister.gov/documents/2000/03/31/00-8005/privacy-act-proposed-new-system-of-records.