Information Collection

State & Local Burden

IC 183226 under ICR 200801-0584-001 · OMB 0584-0548.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0548 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
REV.APPX A-2 WIC State Survey.pdf	Other-Survey
REV. APPX A-4 Local WIC Agency Interview Guide.pdf	Other-Interview Guide
APPX A-5 Data Collection Local Agency.pdf	Other-Program Data - Local WIC Agenc
REV APPX A-6 Local Clinic Interview Guide.pdf	Other-Interview Guide
APPX A-7 Local Clinic Info Form.pdf	Other-Program Data - Local WIC Clini
REVAPPX A-8 Community Collaborators Interview Guide.pdf	Other-Interview Guide
Phone Script Local WIC Agencies.pdf	Other-Telephone Script
APPX A-3 Key Word Definitions for State Survey.pdf	Other-Key Definitions

IC Title:

State & Local Burden

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Program Data - Local WIC Agency	APPX A-5 Data Collection Local Agency.pdf	No		Paper Only
Other-Program Data - Local WIC Clinics	APPX A-7 Local Clinic Info Form.pdf	No		Paper Only
Other-Survey	REV.APPX A-2 WIC State Survey.pdf	Yes	Yes	Fillable Fileable
Other-Interview Guide	REV. APPX A-4 Local WIC Agency Interview Guide.pdf	No		Paper Only
Other-Interview Guide	REVAPPX A-8 Community Collaborators Interview Guide.pdf	No		Paper Only
Other-Interview Guide	REV APPX A-6 Local Clinic Interview Guide.pdf	No		Paper Only
Other-Key Definitions	APPX A-3 Key Word Definitions for State Survey.pdf	No		Printable Only
Other-Telephone Script	Phone Script Local WIC Agencies.pdf	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: FNS Studies and Reports - FNS 8

FR Citation: 56 FR 19079

Number of Respondents: 570

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 43 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	570	570
Annual IC Time Burden (Hours)	457	457
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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