| USDA - RUS |
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Title of Information Document |
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OMB No. |
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0584-NEW |
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| Summary of Information Collection |
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WIC Food Packages - Interim Rule |
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Month/Year |
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Jun-07 |
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| INSTRUCTIONS: |
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| Use this form when a single information collection document involves multiple reporting and |
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| recordkeeping requirements. |
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| IDENTIFICATION OF REPORTING AND RECORDKEEPPING REQUIREMENTS |
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ANNUAL BURDEN |
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FORM |
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REPORTS |
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RECORDS |
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NO(s) |
NO. OF |
NO. OF |
TOTAL |
HOURS |
TOTAL |
NO. OF |
ANNUAL |
TOTAL |
HOURS |
TOTAL |
| SECTION |
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(If "none" |
RESPON- |
RESPONSES |
ANNUAL |
PER |
HOURS |
RECORD- |
RECORDS |
RECORDS |
PER |
RECORD- |
| OF REG |
DESCRIPTION |
so state) |
DENTS |
PER |
RESPONSES |
RESPONSE |
(Col. f & g) |
KEEPERS |
PER |
PER |
RECORD |
KEEPING |
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RESPON- |
(Col. d & e) |
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RECORD- |
RECORD |
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HOURS |
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DENT |
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KEEPER |
KEEPER |
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| (a) |
(b) |
(c) |
(d) |
(e) |
(f) |
(g) |
(h) |
(i) |
(j) |
(k) |
(l) |
(m) |
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| 246.10(d) |
Provide medical documentation |
n/a |
145,985 |
2 |
291,970 |
0.05 |
14,598.50 |
10,000 |
2 |
20,000 |
0.016 |
320.00 |
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TOTALS |
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145,985 |
2.00 |
291,970 |
0.05 |
14,599 |
10,000 |
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20,000 |
0.016 |
320 |
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Line Item |
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Determining |
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SUMMERY OF BURDEN |
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on OMB 83-I |
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Range |
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TOTAL NO. RESPONDENTS |
155,985 |
83-I 13(a) |
Total (d) - Respondent is only counted once |
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AVERAGE NO. OF RESPONSES PER RESPONDENT |
2.00 |
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Total (f)/Total (d) = Total (e) |
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TOTAL ANNUAL RESPONSES |
311,970 |
83-I 13 (b) |
Total (f) + total (k) = Sum |
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AVERAGE HOURS PER RESPONSE |
0.05 |
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Total (h)/Total (f) = Total (g) |
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TOTAL ANNUAL BURDEN (Annual Hours Requested) |
14,919 |
83-I 13(c ) |
Total (h) + Total (m) = Sum |
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CURRENT OMB INVENTORY |
0 |
83-I 13(d) |
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DIFFERENCE |
14,919 |
83-I 13(e) |
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