I/H WIC Participants

WIC Breastfeeding Peer Counseling Study Phase 2

OMB: 0584-0548

IC ID: 198544

Documents and Forms
Document Name
Document Type
Other-Baseline Survey
Other-Followup Survey
Other-Baseline Survey_Spanish
Other-Followup Survey_SpanishOMB
Other-Decline form (English)
Other-Decline Form (Spanish)
Other-Study Invitation Tracking Form
Other-Refusal/Withdraw Form
Other-Consent Form
Other-Appx A2 WIC PeerC Followup Sur
Other-Peer Counseling Study\2011 rev
IC Document
Information Collection (IC) Details

View Information Collection (IC)

I/H WIC Participants
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Baseline Survey Appx A1 WICPeerC Baseline Survey_draft02-jn.docx No   Paper Only
Other-Followup Survey Appx A2 WIC PeerC Followup Survey_draft03-jn.pdf No   Paper Only
Other-Baseline Survey_Spanish Appx A3 Baseline Survey_SpanishOMBDraft02-jn.doc No   Paper Only
Other-Followup Survey_SpanishOMB Appx A4 Followup Survey_SpanishOMBDraft02-jn.doc No   Paper Only
Other-Consent Form Appx F6 Consent Form_ready.doc No   Paper Only
Other-Appx A2 WIC PeerC Followup Survey Appx A2 WIC PeerC Followup Survey_FinalOMB.pdf No   Paper Only
Other-Peer Counseling Study\2011 revised 11-30-11\Appx F6 Consent Form Appx F6 Consent Form_ready.pdf No   Paper Only
Other-Decline form (English) Appx C3 DECLINE form-jn.docx No   Paper Only
Other-Decline Form (Spanish) Appx C4 DECLINE form Spanish__postGG-jn.docx No   Paper Only
Other-Study Invitation Tracking Form Appx C5 STUDY INVITATION TRACKING FORM.doc No   Paper Only
Other-Refusal/Withdraw Form Appx C6 RefusalWithdraw.doc No   Paper Only

Income Security Food and Nutrition Assistance

FNS Studies and Reports - FNS 8  56 FR 19079

1,800 0
   
Individuals or Households
 
   0 %

  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 3,600 0 0 0 0 3,600
Annual IC Time Burden (Hours) 1,200 0 0 0 0 1,200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Brochure Appx F5 Study Brochure_AllPages.pdf 11/21/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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