Information Collection

State & Local Agencies - WIC NSA Study

IC 209205 under ICR 201311-0584-001 · OMB 0584-0589.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0589 can be found here:

2014-04-22 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App A1_WIC State Agency Web Survey_REVISED_08-19-13.docx	Other-App A1_WIC State Agency Web Su
App A2_WIC Local Agency Web Survey_REVISED_08-19-13.docx	Other-App A2_WIC Local Agency Web Su
App A3_Combination WIC Web Survey_REVISED_08-19-13.docx	Other-App A3_Combination WIC Web Sur
App A4_Span Lang WIC Combo Web Survey_08-27-13_REV.docx	Other-App A4_Span Lang WIC Combo Web
App B1_ Case Study Interview Guide for SA_REVISED.docx	Other-App B1_ Case Study Interview G
App B2_Case Study Interview Guide for LA_REVISED.docx	Other-App B2_Case Study Interview Gu
App B3_ Case Study Inter Guide_State SNAP TANF_REVISED.docx	Other-App B3_ Case Study Inter Guide
App B4_ Case Study Inter Guide_County SNAP TANF_REVISED.docx	Other-App B4_ Case Study Inter Guide
App C2_WIC NSA Cost Study Brochure_REV.docx	Other-App C2_WIC NSA Cost Study Broc
App C3_Recruit Letter to WIC SAs with Case Studies_REV.docx	Other-App C3_Recruit Letter to WIC S
App C4_Recruit Letter to SA without Case Studies_REV.docx	Other-App C4_Recruit Letter to SA wi
App C5_Recruit Letter to LA with Case Studies_REV.docx	Other-App C5_Recruit Letter to LA wi
App C6_Span Recruit Letter WIC LA with Case Studies_REV.docx	Other-App C6_Recruit Letter WIC LA w
App C7 _Span Recruit Letter to WIC SAs without Case Studies.docx	Other-App C7 _Span Recruit Letter to
App C8_Recruitment Letter to State SNAP_TANF_REV.docx	Other-App C8_Recruitment Letter to S
App C9_Recruitment Letter to County SNAP_TANF_REV.docx	Other-App C9_Recruitment Letter to C
App C10_ Optional Emai_SAs to encourage LA partic_REV.docx	Other-App C10_ Optional Emai_SAs to

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State & Local Agencies - WIC NSA Study

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?	Can Be Submitted Electronically?	Electronic Capability
Other-App A1_WIC State Agency Web Survey	App A1_WIC State Agency Web Survey_REVISED_08-19-13.docx	Yes	Yes	Fillable Fileable
Other-App A2_WIC Local Agency Web Survey	App A2_WIC Local Agency Web Survey_REVISED_08-19-13.docx	Yes	Yes	Fillable Fileable
Other-App A3_Combination WIC Web Survey	App A3_Combination WIC Web Survey_REVISED_08-19-13.docx	Yes	Yes	Fillable Fileable
Other-App A4_Span Lang WIC Combo Web Survey	App A4_Span Lang WIC Combo Web Survey_08-27-13_REV.docx	Yes	Yes	Fillable Fileable
Other-App B1_ Case Study Interview Guide for SA	App B1_ Case Study Interview Guide for SA_REVISED.docx	No		Paper Only
Other-App B2_Case Study Interview Guide for LA	App B2_Case Study Interview Guide for LA_REVISED.docx	No		Paper Only
Other-App B3_ Case Study Inter Guide_State SNAP TANF	App B3_ Case Study Inter Guide_State SNAP TANF_REVISED.docx	No		Paper Only
Other-App B4_ Case Study Inter Guide_County SNAP TANF	App B4_ Case Study Inter Guide_County SNAP TANF_REVISED.docx	No		Paper Only
Other-App C2_WIC NSA Cost Study Brochure	App C2_WIC NSA Cost Study Brochure_REV.docx	No		Paper Only
Other-App C3_Recruit Letter to WIC SAs with Case Studies	App C3_Recruit Letter to WIC SAs with Case Studies_REV.docx	No		Paper Only
Other-App C4_Recruit Letter to SA without Case Studies_REV	App C4_Recruit Letter to SA without Case Studies_REV.docx	No		Paper Only
Other-App C5_Recruit Letter to LA with Case Studies	App C5_Recruit Letter to LA with Case Studies_REV.docx	No		Paper Only
Other-App C6_Recruit Letter WIC LA without Case Studies	App C6_Span Recruit Letter WIC LA with Case Studies_REV.docx	No		Paper Only
Other-App C7 _Span Recruit Letter to WIC SAs without Case Studies	App C7 _Span Recruit Letter to WIC SAs without Case Studies.docx	No		Paper Only
Other-App C8_Recruitment Letter to State SNAP_TANF	App C8_Recruitment Letter to State SNAP_TANF_REV.docx	No		Paper Only
Other-App C9_Recruitment Letter to County SNAP_TANF	App C9_Recruitment Letter to County SNAP_TANF_REV.docx	No		Paper Only
Other-App C10_ Optional Emai_SAs to encourage LA partic	App C10_ Optional Emai_SAs to encourage LA partic_REV.docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,980

Number of Respondents for Small Entity: 1,710

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 89 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,980	4,980
Annual IC Time Burden (Hours)	2,578	2,578
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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