Information Collection

I/H WIC Participants

IC 198544 under ICR 201111-0584-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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.docx	Other-Baseline Survey
Appx A2 WIC PeerC Followup Survey_draft03-jn.pdf	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 C3 DECLINE form-jn.docx	Other-Decline form (English)
Appx C4 DECLINE form Spanish__postGG-jn.docx	Other-Decline Form (Spanish)
Appx C5 STUDY INVITATION TRACKING FORM.doc	Other-Study Invitation Tracking Form
Appx C6 RefusalWithdraw.doc	Other-Refusal/Withdraw Form
Appx F6 Consent Form_ready.doc	Other-Consent Form
Appx A2 WIC PeerC Followup Survey_FinalOMB.pdf	Other-Appx A2 WIC PeerC Followup Sur
Appx F6 Consent Form_ready.pdf	Other-Peer Counseling Study\2011 rev
Appx F5 Study Brochure_AllPages.pdf Brochure	IC Document

IC Title:

I/H WIC Participants

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?	Electronic Capability
Other-Appx A2 WIC PeerC Followup Survey	Appx A2 WIC PeerC Followup Survey_FinalOMB.pdf	No	Paper Only
Other-Study Invitation Tracking Form	Appx C5 STUDY INVITATION TRACKING FORM.doc	No	Paper Only
Other-Refusal/Withdraw Form	Appx C6 RefusalWithdraw.doc	No	Paper Only
Other-Consent Form	Appx F6 Consent Form_ready.doc	No	Paper Only
Other-Baseline Survey	Appx A1 WICPeerC Baseline Survey_draft02-jn.docx	No	Paper Only
Other-Followup Survey	Appx A2 WIC PeerC Followup Survey_draft03-jn.pdf	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
Other-Decline form (English)	Appx C3 DECLINE form-jn.docx	No	Paper Only
Other-Decline Form (Spanish)	Appx C4 DECLINE form Spanish__postGG-jn.docx	No	Paper Only
Other-Peer Counseling Study\2011 revised 11-30-11\Appx F6 Consent Form	Appx F6 Consent Form_ready.pdf	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
	Approved	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	11/21/2011

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