OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

I/H WIC Participants

IC 198544 under ICR 201404-0584-010 · OMB 0584-0548.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Appx A1 WICPeerC Baseline Survey_draft02-jn.docx Other-Baseline Survey
Appx A2 WIC PeerC Followup Survey_draft03-jn.pdf Other-Followup Survey
Appx A3 Baseline Survey_SpanishOMBDraft02-jn.doc Other-Baseline Survey_Spanish
Appx A4 Followup Survey_SpanishOMBDraft02-jn.doc Other-Followup Survey_SpanishOMB
Appx C3 DECLINE form-jn.docx Other-Decline form (English)
Appx C4 DECLINE form Spanish__postGG-jn.docx Other-Decline Form (Spanish)
Appx C5 STUDY INVITATION TRACKING FORM.doc Other-Study Invitation Tracking Form
Appx C6 RefusalWithdraw.doc Other-Refusal/Withdraw Form
Appx F6 Consent Form_ready.doc Other-Consent Form
Appx A2 WIC PeerC Followup Survey_FinalOMB.pdf Other-Appx A2 WIC PeerC Followup Sur
Appx F6 Consent Form_ready.pdf Other-Peer Counseling Study\2011 rev
Appx F5 Study Brochure_AllPages.pdf
Brochure		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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-Baseline Survey No   Paper Only
Other-Followup Survey No   Paper Only
Other-Baseline Survey_Spanish No   Paper Only
Other-Followup Survey_SpanishOMB No   Paper Only
Other-Decline form (English) No   Paper Only
Other-Decline Form (Spanish) No   Paper Only
Other-Study Invitation Tracking Form No   Paper Only
Other-Refusal/Withdraw Form No   Paper Only
Other-Consent Form No   Paper Only
Other-Appx A2 WIC PeerC Followup Survey No   Paper Only
Other-Peer Counseling Study\2011 revised 11-30-11\Appx F6 Consent Form No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Brochure 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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