Information Collection

I/H WIC Participants

IC 198544 under ICR 201103-0584-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Appx A1 WICPeerC Baseline Survey_draft02-jn.doc	Other-Baseline Survey
Appx A2 WIC PeerC Followup Survey_draft02-jn.doc	Other-Followup Survey
Appx A3 Baseline Survey_SpanishOMBDraft02-jn.doc	Other-Baseline Survey_Spanish
Appx A4 Followup Survey_SpanishOMBDraft02-jn.doc	Other-Followup Survey_SpanishOMB
Appx F5 Study Brochure_AllPages.pdf Brochure	IC Document
Appx F6 Consent Form_ready.doc Consent Form	IC Document

IC Title:

I/H WIC Participants

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?	Electronic Capability
Other-Baseline Survey	Appx A1 WICPeerC Baseline Survey_draft02-jn.doc	No	Paper Only
Other-Followup Survey	Appx A2 WIC PeerC Followup Survey_draft02-jn.doc	No	Paper Only
Other-Baseline Survey_Spanish	Appx A3 Baseline Survey_SpanishOMBDraft02-jn.doc	No	Paper Only
Other-Followup Survey_SpanishOMB	Appx A4 Followup Survey_SpanishOMBDraft02-jn.doc	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS Studies and Reports - FNS 8

FR Citation: 56 FR 19079

Number of Respondents: 1,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	1,200	1,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Brochure	Appx F5 Study Brochure_AllPages.pdf	07/20/2011
Consent Form	Appx F6 Consent Form_ready.doc	07/20/2011

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