Information Collection

State and Local WIC-Screener, Staff, Personnel

IC 203582 under ICR 201404-0584-005 · OMB 0584-0580.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0580 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App.GG_Webinar Presentation- Overview of Study.V3.pdf	Other-App.GG_Webinar Presentation- O
App.II_Email Invitation to State & Local WIC Administrators.docx	Other-App.II_Email Invitation to Sta
App.JJ_Voicemail Invitation to State & Local WIC Administrators.docx	Other-App.JJ_Voicemail Invitation to
App.LL.1.State_Key Informant Interview.docx	Other-App.LL.1.State_Key Informant I
App.LL.2.Local_Key Informant Interview.docx	Other-App.LL.2.Local_Key Informant I
App.C.1_Eng.Participant Referral Script & FAX cover.docx	Other-App.C.1_Eng.Participant Referr
App.C.2_Span Participant Referral Script & FAX cover.docx	Other-App.C.2_Span Participant Refer
App.D.1_Eng.Participant Referral Form.docx	Other-App.D.1_Eng.Participant Referr
App.D.2_Span.Participant Referral Form.docx	Other-App.D.2_Span.Participant Refer
App.MM.1_Eng.Local Staff Online Survey.V2.docx	Other-App.MM.1_Eng.Local Staff Onlin
App.MM.2_Span.Local Staff Online Survey.V2.docx	Other-App.MM.2_Span.Local Staff Onli
App.BB_WIC Admin Data Request.docx	Other-App.BB_WIC Admin Data Request
App.MM.3_Local Staff Online Survey Sample Screen Shots.V2.docx Screen Shots for the Web Survey	IC Document
App.FF_Feeding My Baby Brochure.pdf App.FF_Feeding My Baby Brochure	IC Document
App.HH.Frequently Asked Questions.docx App.HH.Frequently Asked Questions	IC Document
App.KK_Thank you letter - State Not Selected.docx App.KK_Thank you letter - State Not Selected	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State and Local WIC-Screener, Staff, Personnel

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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.GG_Webinar Presentation- Overview of Study	App.GG_Webinar Presentation- Overview of Study.V3.pdf	Yes	Yes	Fillable Fileable
Other-App.II_Email Invitation to State & Local WIC Administrators	App.II_Email Invitation to State & Local WIC Administrators.docx	No		Paper Only
Other-App.JJ_Voicemail Invitation to State & Local WIC Administrators	App.JJ_Voicemail Invitation to State & Local WIC Administrators.docx	No		Paper Only
Other-App.LL.1.State_Key Informant Interview	App.LL.1.State_Key Informant Interview.docx	Yes	Yes	Fillable Fileable
Other-App.LL.2.Local_Key Informant Interview	App.LL.2.Local_Key Informant Interview.docx	Yes	Yes	Fillable Fileable
Other-App.C.1_Eng.Participant Referral Script & FAX cover	App.C.1_Eng.Participant Referral Script & FAX cover.docx	No		Paper Only
Other-App.C.2_Span Participant Referral Script & FAX cover	App.C.2_Span Participant Referral Script & FAX cover.docx	No		Paper Only
Other-App.D.1_Eng.Participant Referral Form.docx	App.D.1_Eng.Participant Referral Form.docx	Yes	Yes	Fillable Fileable
Other-App.D.2_Span.Participant Referral Form.docx	App.D.2_Span.Participant Referral Form.docx	Yes	Yes	Fillable Fileable
Other-App.MM.1_Eng.Local Staff Online Survey.V2	App.MM.1_Eng.Local Staff Online Survey.V2.docx	Yes	Yes	Fillable Fileable
Other-App.MM.2_Span.Local Staff Online Survey.V2	App.MM.2_Span.Local Staff Online Survey.V2.docx	Yes	Yes	Fillable Fileable
Other-App.BB_WIC Admin Data Request	App.BB_WIC Admin Data Request.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: Privacy Act of 1974

FR Citation: 5 FR 552

Number of Respondents: 862

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 99 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	441	441
Annual IC Time Burden (Hours)	418	418
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screen Shots for the Web Survey	App.MM.3_Local Staff Online Survey Sample Screen Shots.V2.docx	12/18/2012
App.FF_Feeding My Baby Brochure	App.FF_Feeding My Baby Brochure.pdf	12/18/2012
App.HH.Frequently Asked Questions	App.HH.Frequently Asked Questions.docx	12/18/2012
App.KK_Thank you letter - State Not Selected	App.KK_Thank you letter - State Not Selected.docx	12/18/2012

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