State, Local or Tribal Government

Assessing SNAP Participants’ Fitness for Work (New)

OMB: 0584-0675

IC ID: 253891

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0675 can be found here:

2023-02-08 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Appendix C. Final State and Local SNAP Administrator Interview Guide.docx Other-Appendix C. Final State and Lo
Appendix C. Final State and Local SNAP Administrator Interview Guide.docx Other-Appendix C. Final State and Lo
Appendix D. Final State SNAP Eligibility Workers Interview Guide.docx Other-Appendix D. Final State SNAP E
Appendix D. Final State SNAP Eligibility Workers Interview Guide.docx Other-Appendix D. Final State SNAP E
Appendix G. Informed Consent Form.docx Other-Appendix G. Informed Consent F
Appendix G. Informed Consent Form.docx Other-Appendix G. Informed Consent F
Appendix H. Observation Guide.docx Other-Appendix H. Observation Guide
Appendix H. Observation Guide.docx Other-Appendix H. Observation Guide
Appendix L. Survey Recruitment Email.docx Other-Appendix L. Survey Recruitment
Appendix L. Survey Recruitment Email.docx Other-Appendix L. Survey Recruitment
Appendix M. Survey Invitation Email.docx Other-Appendix M. Survey Invitation
Appendix M. Survey Invitation Email.docx Other-Appendix M. Survey Invitation
Appendix T. Case Study Recruitment Email from FNS.docx Other-Appendix T. Case Study Recruit
Appendix T. Case Study Recruitment Email from FNS.docx Other-Appendix T. Case Study Recruit
Appendix U. Case Study Recruitment Email from Project Team.docx Other-Appendix U. Case Study Recruit
Appendix U. Case Study Recruitment Email from Project Team.docx Other-Appendix U. Case Study Recruit
Appendix F. Informed Consent Script for Interviews.docx Other-Appendix F. Informed Consent S
Appendix F. Informed Consent Script for Interviews.docx Other-Appendix F. Informed Consent S
Appendix B. Final State SNAP Agency Survey Instrument.docx Other-Appendix B. Final State SNAP A
Appendix B. Final State SNAP Agency Survey Instrument.docx Other-Appendix B. Final State SNAP A
Appendix I. List of Requested Administrative Data Elements.docx Other-Appendix I. List of Requested
Appendix I. List of Requested Administrative Data Elements.docx Other-Appendix I. List of Requested
Appendix K. Web Survey.pdf Other-Appendix K. Web Survey
Appendix K. Web Survey.pdf Other-Appendix K. Web Survey
Appendix O. Survey Thank You Email.docx Appendix O. Survey Thank You Email IC Document
Appendix O. Survey Thank You Email.docx Appendix O. Survey Thank You Email IC Document
Appendix P. Survey Reminder Email for Partial Completers.docx Appendix P. Survey Reminder Email for Partial Completers IC Document
Appendix P. Survey Reminder Email for Partial Completers.docx Appendix P. Survey Reminder Email for Partial Completers IC Document
Appendix Q. Survey Reminder Email for Non-Completers.docx Appendix Q. Survey Reminder Email for Non-Completers IC Document
Appendix Q. Survey Reminder Email for Non-Completers.docx Appendix Q. Survey Reminder Email for Non-Completers IC Document
Appendix R. Survey Reminder for Uploading Non-Public Documents.docx Appendix R. Survey Reminder for Uploading Non-Public Documents IC Document
Appendix R. Survey Reminder for Uploading Non-Public Documents.docx Appendix R. Survey Reminder for Uploading Non-Public Documents IC Document
Appendix S. Final Survey Reminder Email.docx Appendix S. Final Survey Reminder Email IC Document
Appendix S. Final Survey Reminder Email.docx Appendix S. Final Survey Reminder Email IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State, Local or Tribal Government	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix C. Final State and Local SNAP Administrator Interview Guide	Appendix C. Final State and Local SNAP Administrator Interview Guide.docx	No		Paper Only
Other-Appendix D. Final State SNAP Eligibility Workers Interview Guide	Appendix D. Final State SNAP Eligibility Workers Interview Guide.docx	No		Paper Only
Other-Appendix G. Informed Consent Form	Appendix G. Informed Consent Form.docx	No		Paper Only
Other-Appendix H. Observation Guide	Appendix H. Observation Guide.docx	No		Paper Only
Other-Appendix L. Survey Recruitment Email	Appendix L. Survey Recruitment Email.docx	Yes	No	Printable Only
Other-Appendix M. Survey Invitation Email	Appendix M. Survey Invitation Email.docx	Yes	No	Printable Only
Other-Appendix T. Case Study Recruitment Email from FNS	Appendix T. Case Study Recruitment Email from FNS.docx	Yes	No	Printable Only
Other-Appendix U. Case Study Recruitment Email from Project Team	Appendix U. Case Study Recruitment Email from Project Team.docx	Yes	No	Printable Only
Other-Appendix F. Informed Consent Script for Interviews	Appendix F. Informed Consent Script for Interviews.docx	No		Paper Only
Other-Appendix B. Final State SNAP Agency Survey Instrument	Appendix B. Final State SNAP Agency Survey Instrument.docx	Yes	Yes	Fillable Printable
Other-Appendix I. List of Requested Administrative Data Elements	Appendix I. List of Requested Administrative Data Elements.docx	No		Paper Only
Other-Appendix K. Web Survey	Appendix K. Web Survey.pdf	Yes	Yes	Fillable Printable

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: 296	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 55 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	935	935
Annual IC Time Burden (Hours)	310	310
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix O. Survey Thank You Email	Appendix O. Survey Thank You Email.docx	05/26/2022
Appendix P. Survey Reminder Email for Partial Completers	Appendix P. Survey Reminder Email for Partial Completers.docx	05/26/2022
Appendix Q. Survey Reminder Email for Non-Completers	Appendix Q. Survey Reminder Email for Non-Completers.docx	05/26/2022
Appendix R. Survey Reminder for Uploading Non-Public Documents	Appendix R. Survey Reminder for Uploading Non-Public Documents.docx	05/26/2022
Appendix S. Final Survey Reminder Email	Appendix S. Final Survey Reminder Email.docx	05/26/2022

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