Appendix
L. SNAP Office 
Waiting Room Questionnaire
OMB No. 0584-XXXX
Modernizing
Channels of Communication 
With SNAP Participants
March 2, 2020
Office of Policy Support
Food and Nutrition Service
U.S. Department of Agriculture
1320 Braddock Place
Alexandria, VA 22314
703.305.1091
Andrew.Burns@usda.gov
Modernizing
Channels of Communication With SNAP Participants: 
SNAP Office
Waiting Room Questionnaire
	PURPOSE:
	The goal of this questionnaire is to assess the awareness and
	usefulness of MCS among potential SNAP applicants. On behalf of the
	Food and Nutrition Service, during the site visits to local SNAP
	offices, Insight staff will conduct a brief survey with local SNAP
	offices. Insight staff will conduct a verbal survey to collect
	information about the MCS among users and nonusers. Information on
	the awareness and perceived helpfulness of the MCS will be collected
	in a 5- to 7-minute survey. 
	 
Do you have 5 minutes to talk about using your phone to get information about SNAP? If you participate, you’ll will have an opportunity to randomly receive a $10 Visa/Mastercard/Discover/Amex gift card. There will be two individuals randomly selected at the end of today.
Are you at least 18 years old?
Yes
No
[IF NO, THANK THEM FOR THEIR TIME AND INFORM THEM THEY ARE INELIGIBLE FOR THE RAFFLE]
Are you currently applying for SNAP benefits or receiving SNAP benefits?
Yes
No
[IF NO, THANK THEM FOR THEIR TIME AND INFORM THEM THEY ARE INELIGIBLE FOR THE RAFFLE]
Why did you come into the [LOCAL SNAP OFFICE] today?
Apply for SNAP benefits
Apply for other benefits
Provide recertification documents
Have an interview
Ask a question related to benefits
Check the status of SNAP balance
 
		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 1 hour 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 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. 
	
Other_______________
Do you have a smartphone, tablet, or other mobile device you can use to connect to the Internet?
Yes
No
Have you ever used your smartphone to get information about SNAP through a website or app? If so, what did you do?
Probe: Can you tell me about what it was like? Did you get the information you needed or do what you needed to do? Was it easy to use?
Probe: Did using this mobile technology save you time? For instance, did it save you a trip to your local office or from making a phone call and waiting on hold?
| [ENTER PARTICIPANTS’ RESPONSE] 
 | 
What part of the SNAP process do you wish you could do on your phone via text message, mobile app, or a website viewed on your phone?
| [ENTER PARTICIPANTS’ RESPONSE] 
 | 
How could [LOCAL SNAP OFFICE] better connect with you on your mobile device via text message, mobile app, or a website viewed on your phone?
| [ENTER PARTICIPANTS’ RESPONSE] 
 | 
Did you know that you can perform the following actions via a smartphone?
[ASK EACH QUESTION ONE AT A TIME—CHECK YES OR NO FOR EACH, AS APPLICABLE FOR THE STATE]
| Function | YES | NO | 
| Apply for SNAP benefits | 
				 | 
				 | 
| Check your application status | 
				 | 
				 | 
| Check your benefit amount | 
				 | 
				 | 
| Upload documents for recertification | 
				 | 
				 | 
| Receive text message notifications about your SNAP application or account | 
				 | 
				 | 
| Access the SNAP website to obtain information about SNAP | 
				 | 
				 | 
| Submit questions | 
				 | 
				 | 
If you could pick one SNAP-related activity you would like to do using your phone, what would it be?
Probe: Some examples are the activities we just discussed—or you can mention activities not previously mentioned.
| [ENTER PARTICIPANTS’ RESPONSE] 
 | 
My final question for you is, what is the best phone number or email for reaching you if you were randomly selected to receive the $10 Visa/Mastercard/Discover/Amex gift card?
[EMAIL OR PHONE NUMBER]__________________________________
Thank you for your time. If you are a selected to receive the $10 Visa/Mastercard/Discover/Amex gift card, you will be notified by your preferred contact method by 8 p.m. tonight.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| File Modified | 0000-00-00 | 
| File Created | 0000-00-00 |