Appendix
O. SNAP Participants 
Focus Group Demographic 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 Participants Focus Group Demographic Questionnaire
 
	PURPOSE:
	This demographic questionnaire will be administered prior to the
	focus group discussion. Participants will be handed a hardcopy
	version of the questionnaire. Insight staff will collect the
	completed questionnaire prior to the start of the focus group. 
	 
How old are you?
18 to 25
26 to 35
36 to 50
51 to 64
65+
What is your gender? __________________
What is your current employment status?
Employed full time (35+ hours/week)
Employed part time (1 to 34 hours/week)
Not employed
What is your education level?
Grade school or some high school
High school graduate or GED
Some college, technical, or vocational school
Two-year degree
Four-year college degree or higher
Including you, how many people are currently in your SNAP household?
One person (just me)
2–3 people
4–6 people
 
		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 5 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 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. 
	
6
or more people _______
Including you, how many people currently live or stay in your home? _______
About how many years have you been receiving SNAP benefits? __________________
Where do you access the internet? (Select all that apply)
Home
Work or school
Friend’s or relative’s house
Community location (e.g., library, community center, cafe)
Mobile device (e.g., phone)
Other (please specify_____________________)
What are the different devices you use to access the internet? (Select all that apply)
Smartphone
Desktop or laptop
Tablet
E-reader
Smart watch
Smart TV
Other (please specify_____________________)
What are all the ways you pay for the internet on your phone or tablet?
Unlimited monthly data plan
Limited monthly data plan
Pay-as-you-go data plan
Government-subsidized phone plan (e.g., a set amount of data is provided free, and any additional amount is paid for by phone holder)
Other (please specify_____________________)
Not applicable—I do not pay for the internet on my phone or tablet
How do you connect to the internet on your phone? (Select all that apply)
Data plan
Wi-Fi connection
Other (please specify_____________________)
Which mobile device do you plan to bring? Phone and/or tablet? _____
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| File Modified | 0000-00-00 | 
| File Created | 0000-00-00 |