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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.