Information Collection

WIC Special Project Grants

IC 212085 under ICR 201209-0584-003 · OMB 0584-0512.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0512 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
WIC SPG FullMini Grant FY 2014 RFA_Final.7.1.14.doc	Other-Request for Application
2014 WIC SPG Concept Paper RFA - Final.7.1.14.doc	Other-Request for Application
Request to OMB to Use 0584-0512 (WIC Special Project Grants).docx Generic Clearance Memo	IC Document
FY2014 WIC Special Project Grant Supporting Statement7-2-14 rev 2.docx Supporting Statement	IC Document
Terms and Conditions - FINAL.docx Terms and Conditions	IC Document
SF-425 screenshot July 2013.docx SF-425 screenshot July 2013	IC Document
SF-LLL Lobbying Form.pdf SF-LLL Lobbying Form	IC Document
SF424_2_1-V2.1.pdf SF 424 Application for Federal Assistance	IC Document
SF424A-V1.0.pdf SF 424A Budget Information Non Construction Programs	IC Document
SF424B-V1.1.pdf SF 424B Assurances Non Construction Programs	IC Document
AD1049-F-05-90.pdf AD 1049 CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS) ALTERNATIVE I - FOR GRANTEES OTHER THAN INDIVIDUALS	IC Document
AD1050-F-01-92.pdf AD 1050 CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS) ALTERNATIVE II - FOR GRANTEES WHO ARE INDIVIDUALS	IC Document

IC Title:

WIC Special Project Grants

Agency IC Tracking Number:

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-Request for Application				www.grants.gov	Yes	Yes	Fillable Fileable Signable
Other-Request for Application				www.grants.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	159	159
Annual IC Time Burden (Hours)	1,064	1,064
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Clearance Memo		07/02/2014
Supporting Statement		07/07/2014
Terms and Conditions		07/02/2014
SF-425 screenshot July 2013		07/02/2014
SF-LLL Lobbying Form		07/02/2014
SF 424 Application for Federal Assistance		07/02/2014
SF 424A Budget Information Non Construction Programs		07/02/2014
SF 424B Assurances Non Construction Programs		07/02/2014
AD 1049 CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS) ALTERNATIVE I - FOR GRANTEES OTHER THAN INDIVIDUALS		07/02/2014
AD 1050 CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS (GRANTS) ALTERNATIVE II - FOR GRANTEES WHO ARE INDIVIDUALS		07/02/2014

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

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