Information Collection

Web Survey

IC 203557 under ICR 201208-0584-001 · OMB 0584-0574.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0574 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
WICBPI_App_A (final v2).docx	Other-Web Survey
WICBPI_App_B (final v2).docx Appendix B: Example Screenshots of Web Survey	IC Document
WICBPI_App_C (final v2).docx Appendix C: Regional Field Office Advance Letter	IC Document
WICBPI_App_D (final v2).docx Appendix D: Respondent Advance Letter	IC Document
WICBPI_App_E (final v2).docx Appendix E: Respondent Frequently Asked Questions	IC Document
WICBPI_App_F (final v2).docx Appendix F: Respondent Email Invitations	IC Document
WICBPI_App_G (final v2).docx Appendix G: Respondent Reminder Email	IC Document
WICBPI_App_H (final v2).docx Appendix H: Respondent Reminder Post Card	IC Document
WICBPI_App_I (final v2).docx Appendix I : Respondent Reminder Telephone Call	IC Document
WICBPI_App_J (final v2).docx Appendix J: Respondent Thank You Email	IC Document

IC Title:

Web Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web Survey			WICBPI_App_A (final v2).docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,672

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,353	3,353
Annual IC Time Burden (Hours)	2,889	2,889
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix B: Example Screenshots of Web Survey	WICBPI_App_B (final v2).docx	08/02/2012
Appendix C: Regional Field Office Advance Letter	WICBPI_App_C (final v2).docx	08/02/2012
Appendix D: Respondent Advance Letter	WICBPI_App_D (final v2).docx	08/02/2012
Appendix E: Respondent Frequently Asked Questions	WICBPI_App_E (final v2).docx	08/02/2012
Appendix F: Respondent Email Invitations	WICBPI_App_F (final v2).docx	08/02/2012
Appendix G: Respondent Reminder Email	WICBPI_App_G (final v2).docx	08/02/2012
Appendix H: Respondent Reminder Post Card	WICBPI_App_H (final v2).docx	08/02/2012
Appendix I : Respondent Reminder Telephone Call	WICBPI_App_I (final v2).docx	08/02/2012
Appendix J: Respondent Thank You Email	WICBPI_App_J (final v2).docx	08/02/2012

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