Information Collection

WIC NE State & Local - Phase I

IC 212149 under ICR 201406-0584-002 · OMB 0584-0599.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
A.1_SA Info Request State Plans_Sampling.doc	Other-A.1_SA Info Request State Plan
A.2_LA Info Request Sampling.doc	Other-A.2_LA Info Request Sampling
B.1_LA Web Survey_REV.docx	Other-B.1_LA Web Survey_REV
B.2_LA Paper Survey_REV.docx	Other-B.2_LA Paper Survey_REV
B.3_LA Web_Survey SampleScreenshots.docx	Other-B.3_LA Web_Survey SampleScreen
C.1_Site Web Survey_Version1_.docx	Other-C.1_Site Web Survey_Version1_
C.2_Site Web Survey_Version2_REV.docx	Other-C.2_Site Web Survey_Version2_R
C.3_Site Paper Survey_Version1_REV.docx	Other-C.3_Site Paper Survey_Version1
C.4_Site Paper Survey_Version2_REV.docx	Other-C.4_Site Paper Survey_Version2
C.5_Site_Paper_Survey_Version1_Spanish.docx	Other-C.5_Site_Paper_Survey_Version1
C.6_Site_Paper_Survey_Version2_Spanish.docx	Other-C.6_Site_Paper_Survey_Version2
C.7_Site Web Survey SampleScreenshots.docx	Other-C.7_Site Web Survey SampleScre
G_SA Invite.doc	Other-G_SA Invite
O_Phase I_SiteIntGuide.docx	Other-O_Phase I_SiteIntGuide
I.1_LA Invite.docx I.1_LA Invite	IC Document
F_Phase I Brochure.doc F_Phase I Brochure	IC Document
H.1_Phase I FAQ_English.docx H.1_Phase I FAQ_English	IC Document
H.2_Phase I FAQ_Spanish.docx H.2_Phase I FAQ_Spanish.docx	IC Document
J.1_Site Invite.docx J.1_Site Invite	IC Document
J.2_Site Invite_Spanish.docx J.2_Site Invite_Spanish	IC Document
G_SA Invite.doc G_SA Invite	IC Document
E_SA Announce Email_REVkcb.doc E_SA Announce Email_REVkcb	IC Document
K.1_LA Survey Remind 1.docx K.1_LA Survey Remind 1	IC Document
K.2_LA Survey Remind 2.docx K.2_LA Survey Remind 2.docx	IC Document
K.3_LA Survey Remind 3.docx K.3_LA Survey Remind 3.docx	IC Document
K.4_LA Survey Remind 4.docx K.4_LA Survey Remind 4.docx	IC Document
L.1_Site Email Remind 1.docx L.1_Site Email Remind 1.docx	IC Document
L.2_Site Letter Remind 1.docx L.2_Site Letter Remind 1.docx	IC Document
L.3_Site Letter Reminder1_Spanish.docx L.3_Site Letter Reminder1_Spanish.docx	IC Document
M_SA Nonrespond Email.docx M_SA Nonrespond Email.docx	IC Document
N_LA Remind Scrpt.docx N_LA Remind Scrpt.docx	IC Document
P_Site Interviews Email Invite.docx P_Site Interviews Email Invite.docx	IC Document
Q_Site Interviews Phone Schedule.docx Q_Site Interviews Phone Schedule.docx	IC Document
R_Site Interviews Email Reminder.docx R_Site Interviews Email Reminder.docx	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

WIC NE State & Local - Phase I

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-A.1_SA Info Request State Plans_Sampling	No		Printable Only
Other-A.2_LA Info Request Sampling	No		Printable Only
Other-B.1_LA Web Survey_REV	Yes	Yes	Fillable Fileable
Other-B.2_LA Paper Survey_REV	No		Paper Only
Other-B.3_LA Web_Survey SampleScreenshots	Yes	Yes	Fillable Fileable
Other-C.1_Site Web Survey_Version1_	Yes	Yes	Fillable Fileable
Other-C.2_Site Web Survey_Version2_REV	Yes	Yes	Fillable Fileable
Other-C.3_Site Paper Survey_Version1_REV	No		Paper Only
Other-C.4_Site Paper Survey_Version2_REV	No		Paper Only
Other-C.5_Site_Paper_Survey_Version1_Spanish	No		Paper Only
Other-C.6_Site_Paper_Survey_Version2_Spanish	No		Paper Only
Other-C.7_Site Web Survey SampleScreenshots	Yes	Yes	Fillable Fileable
Other-G_SA Invite	No		Printable Only
Other-O_Phase I_SiteIntGuide	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: FNS-8 USDA/FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 2,400

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 87 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,149	2,149
Annual IC Time Burden (Hours)	712	712
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
I.1_LA Invite		06/28/2014
F_Phase I Brochure		07/22/2014
H.1_Phase I FAQ_English		06/28/2014
H.2_Phase I FAQ_Spanish.docx		06/29/2014
J.1_Site Invite		06/28/2014
J.2_Site Invite_Spanish		06/28/2014
G_SA Invite		06/28/2014
E_SA Announce Email_REVkcb		06/28/2014
K.1_LA Survey Remind 1		06/28/2014
K.2_LA Survey Remind 2.docx		06/28/2014
K.3_LA Survey Remind 3.docx		06/28/2014
K.4_LA Survey Remind 4.docx		06/28/2014
L.1_Site Email Remind 1.docx		06/28/2014
L.2_Site Letter Remind 1.docx		06/28/2014
L.3_Site Letter Reminder1_Spanish.docx		06/28/2014
M_SA Nonrespond Email.docx		06/28/2014
N_LA Remind Scrpt.docx		06/28/2014
P_Site Interviews Email Invite.docx		06/28/2014
Q_Site Interviews Phone Schedule.docx		06/28/2014
R_Site Interviews Email Reminder.docx		06/28/2014

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

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