State, Local and/or Tribal Agencies

WIC Breastfeeding Peer Counseling Study Phase 2

OMB: 0584-0548

IC ID: 183226

Documents and Forms
Document Name
Document Type
Other-PeerCounsBackQuest
Other- DemPerProgForm
Other-Study Enrollment Form
Other-STUDY INVITATION TRACKING FORM
Other-Contact Log Abstraction Form
Other-LWA Staff Interview Guide
Other-Interview Guide 2
Other-nterview Guide 3
Other-SA Survey Screenshot
Other-Appx B PeerCounsBackQust Final
Other-Appx B PeerCounsBackQust Final
Other-Appx E2 WICPeerC_InterviewGuid
Other-Appx E3 WICPeerC_InterviewGuid
Other-Attachment A: Phase 2 Survey
Other-Attachment B - Letter to Regio
Other-Attachment C - Letter to State
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

State, Local and/or Tribal Agencies
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-PeerCounsBackQuest Appx B PeerCounsBackQust Draft02-jn.doc No   Paper Only
Other- DemPerProgForm Appx C1 DemPerProgForm.doc No   Paper Only
Other-Study Enrollment Form Appx C2 Study Enrollment Form Draft02-jn.doc No   Paper Only
Other-STUDY INVITATION TRACKING FORM Appx C5 STUDY INVITATION TRACKING FORM.doc No   Paper Only
Other-Contact Log Abstraction Form Appx D Contact Log Abstraction Form-jn.doc www.notcreated.com Yes Yes Fillable Fileable Signable
Other-LWA Staff Interview Guide Appx E1 LWA Staff Interview Guide 1-jn.docx No   Paper Only
Other-Interview Guide 2 Appx E2 WICPeerC_InterviewGuide2_OMB_Draft03-jn.pdf No   Paper Only
Other-nterview Guide 3 Appx E3 WICPeerC_InterviewGuide3_OMB_Draft03-jn.pdf No   Paper Only
Other-SA Survey Screenshot 0584-0548 State Agency Survey paper 6-09 formatted.pdf http://mobile.checkbox.com/abtassociates/WIC_PEERC_Intro.survey Yes Yes Fillable Fileable Signable
Other-Appx B PeerCounsBackQust FinalOMB Appx B PeerCounsBackQust FinalOMB.pdf No   Paper Only
Other-Appx B PeerCounsBackQust FinalOMB Appx E1 LWA Staff Interview Guide 1_FinalOMB.pdf No   Paper Only
Other-Appx E2 WICPeerC_InterviewGuide2_FinalOMB Appx E2 WICPeerC_InterviewGuide2_FinalOMB.pdf No   Paper Only
Other-Appx E3 WICPeerC_InterviewGuide3_FinalOMB Appx E3 WICPeerC_InterviewGuide3_FinalOMB.pdf No   Paper Only
Other-Attachment A: Phase 2 Survey Attachment A - Phase 2 Survey.docx Yes Yes Fillable Fileable
Other-Attachment B - Letter to Regional WIC Offices Attachment B - Letter to Regional WIC Offices_omb.docx No   Paper Only
Other-Attachment C - Letter to StateWIC Attachment C - Letter to StateWIC_omb.docx No   Paper Only

Health Public Health Monitoring

FNS Studies and Reports - FNS 8  56 FR 19079

96 0
   
State, Local, and Tribal Governments
 
   43 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 5,457 0 153 0 0 5,304
Annual IC Time Burden (Hours) 1,210 0 102 0 0 1,108
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Phase II Prelim Letter to States Appx F1 Phase II Prelim Letter to States_5 3 11-jn.docx 11/21/2011
Funding Opp Announce Appx F2 FundingOppAnnounce_COMPLETE.doc 07/20/2011
MOU_Sample Appx F3 MOU_Sample-jn.docx 07/20/2011
Nondisclosure and Confidentiality Form Appx F4 Nondisclosure.doc 07/20/2011
ResptoOMBTermsofClearance ResptoOMBTermsofClearance.doc 11/21/2011
OMB_reply_FNSfollowup OMB_reply_FNSfollowup Draft03 final.docx 12/01/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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