J. Client Consent Form for Observations

Appendix J. Client Consent Form for Observations

OMB No. 0584-[NEW]

Assessment of Mandatory E&T Programs

Month XX, 2018

Project Officer: Jordan Younes

Office of Policy Support

Food and Nutrition Service

U.S. Department of Agriculture

3101 Park Center Drive

Alexandria, VA 22303

703-305-2935

Jordan.younes@fns.usda.gov

Assessment of Mandatory E&T Programs: Client Observation Consent Form

Introduction/ Verbal consent for Observations

Hello, my name is [YOUR NAME], and I am here to observe how the SNAP Office informs clients, like you, of the SNAP Employment and Training (E&T) program.

I am here on behalf of the US Department of Agriculture, the agency that runs SNAP, which is also known as the Food Stamp program.

The USDA is doing a study to understand the program features and administrative aspects of SNAP employment and training programs, such as how clients learn of their participation in E&T and how they interact with their local SNAP office throughout the entire process.

I’ve asked the staff here if it would be okay for me to observe their interactions with clients regarding referrals to E&T and any other discussion of E&T program aspects. Would be ok if I sat in and watched? Of course, you are free to say no. The reason I want to observe is just so I can see how the E&T process works here.

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 2 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-xxxx*). Do not return the completed form to this address.

[OBTAIN VERBAL CONSENT]