Information Collection

National Survey of WIC Participants

IC 3087 under ICR 200810-0584-001 · OMB 0584-0484.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
APPENDIX F - DENIALS 1-30-09.pdf	Other-Survey
APPENDIX G - TERMINATIONS 1-30-09.pdf	Other-Survey
APPENDIX H - CALLBACK SCRIPT 2-03-09.pdf	Other-Callback Script
APPENDIX E(A) - PREG BF PP 2-20-09.pdf	Other-Survey
APPENDIX E(B) - INFANTS CHILDREN 2-20-09.pdf	Other-Survey
APPENDIX A-1 A-2 CONFID CONSENT 1-30-09.pdf Consent Form - Participants	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Survey	APPENDIX E(A) - PREG BF PP 2-20-09.pdf	No		Paper Only
Other-Survey	APPENDIX E(B) - INFANTS CHILDREN 2-20-09.pdf	No		Paper Only
Other-Survey	APPENDIX F - DENIALS 1-30-09.pdf	Yes	Yes	Fillable Fileable
Other-Survey	APPENDIX G - TERMINATIONS 1-30-09.pdf	Yes	Yes	Fillable Fileable
Other-Callback Script	APPENDIX H - CALLBACK SCRIPT 2-03-09.pdf	No		Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 2,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,400	-2,180	4,580
Annual IC Time Burden (Hours)	1,760	-976	2,736
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent Form - Participants	APPENDIX A-1 A-2 CONFID CONSENT 1-30-09.pdf	03/12/2009

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