Information Collection

WIC NE Individuals/Household - Phase II

IC 212153 under ICR 201406-0584-002 · OMB 0584-0599.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
AA.1_Part Screener.doc	Other-AA.1_Part Screener
AA.2_Part Screener_Spanish.doc	Other-AA.2_Part Screener_Spanish
CC.1_Pregnant_Baseline PAPI English.docx	Other-CC.1_Pregnant_Baseline PAPI En
CC.2_Pregnant_Baseline PAPI Spanish.docx	Other-CC.2_Pregnant_Baseline PAPI Sp
DD.1_Postpartum_Baseline PAPI English.docx	Other-DD.1_Postpartum_Baseline PAPI
DD.2_Postpartum_Baseline PAPI Spanish.docx	Other-DD.2_Postpartum_Baseline PAPI
EE.1_Child_Baseline PAPI English.doc	Other-EE.1_Child_Baseline PAPI Engli
EE.2_Child_Baseline PAPI Spanish.doc	Other-EE.2_Child_Baseline PAPI Spani
FF.1_Pregnant_Interim PAPI English.docx	Other-FF.1_Pregnant_Interim PAPI Eng
FF.2_Pregnant_Interim PAPI Spanish.docx	Other-FF.2_Pregnant_Interim PAPI Spa
GG.1_Postpartum_Interim PAPI English.docx	Other-GG.1_Postpartum_Interim PAPI E
GG.2_Postpartum_Interim PAPI Spanish.docx	Other-GG.2_Postpartum_Interim PAPI S
HH.1_Child_Interim PAPI English.doc	Other-HH.1_Child_Interim PAPI Englis
HH.2_Child_Interim PAPI Spanish.doc	Other-HH.2_Child_Interim PAPI Spanis
LL.1_Pregnant_Interim CATI English.docx	Other-LL.1_Pregnant_Interim CATI Eng
LL.2_Pregnant_Interim CATI Spanish.docx	Other-LL.2_Pregnant_Interim CATI Spa
MM.1_Postpartum_Interim CATI English.docx	Other-MM.1_Postpartum_Interim CATI E
MM.2_Postpartum_Interim CATI Spanish.docx	Other-MM.2_Postpartum_Interim CATI S
NN.1_Child_Interim CATI English.doc	Other-NN.1_Child_Interim CATI Englis
NN.2_Child_Interim CATI Spanish.doc	Other-NN.2_Child_Interim CATI Spanis
II.1_Pregnant_Final PAPI English.docx	Other-II.1_Pregnant_Final PAPI Engli
II.2_Pregnant_Final PAPI Spanish.docx	Other-II.2_Pregnant_Final PAPI Spani
JJ.1_Postpartum_Final PAPI English.docx	Other-JJ.1_Postpartum_Final PAPI Eng
JJ.2_Postpartum_Final PAPI Spanish.docx	Other-JJ.2_Postpartum_Final PAPI Spa
KK.1_Child_Final PAPI EnglishEdited.doc	Other-KK.1_Child_Final PAPI EnglishE
KK.2_Child_Final PAPI Spanish.doc	Other-KK.2_Child_Final PAPI Spanish.
PP.1_Postpartum_Final CATI English.docx	Other-PP.1_Postpartum_Final CATI Eng
PP.2_Postpartum_Final CATI Spanish.docx	Other-PP.2_Postpartum_Final CATI Spa
QQ.1_Child_Final CATI English.doc	Other-QQ.1_Child_Final CATI English.
QQ.2_Child_Final CATI Spanish.doc	Other-QQ.2_Child_Final CATI Spanish.
JJJ.1_FG Mod Guide_English.doc	Other-JJJ.1_FG Mod Guide_English.doc
JJJ.2-FS Mod Guide_Spanish..docx	Other-JJJ.2-FS Mod Guide_Spanish.doc
OO.1_Pregnant_Final CATI English.docx	Other-OO.1_Pregnant_Final CATI Engli
OO.2_Pregnant_Final CATI Spanish.docx	Other-OO.2_Pregnant_Final CATI Spani
BB.1_Part Consent.docx BB.1_Part Consent.docx	IC Document
BB.2_Part Consent_Spanish.docx BB.2_Part Consent_Spanish.docx	IC Document
WW.1_Intrm Cov Letter.docx WW.1_Intrm Cov Letter.docx	IC Document
WW.2_Intrm Cov Letter_Spanish.docx WW.2_Intrm Cov Letter_Spanish.docx	IC Document
ZZ.1_Intrm Cov Letter 2.docx ZZ.1_Intrm Cov Letter 2.docx	IC Document
ZZ.2_Intrm Cov Letter 2_Spanish_.doc ZZ.2_Intrm Cov Letter 2_Spanish.doc	IC Document
DDD.1_Final Cov Letter.docx DDD.1_Final Cov Letter.docx	IC Document
DDD.2_Final Cov Letter_Spanish.docx DDD.2_Final Cov Letter_Spanish.docx	IC Document
GGG.1_Final Cov Letter 2.docx GGG.1_Final Cov Letter 2.docx	IC Document
GGG.2_Final Cov Letter 2_Spanish.docx GGG.2_Final Cov Letter 2_Spanish.docx	IC Document
OOO.1_FG Consent.docx OOO.1_FG Consent.docx	IC Document
OOO.2_FG_Consent_Spanish.docx OOO.2_FG_Consent_Spanish.docx	IC Document
AAA.1_Intrm Reminder Call.doc AAA.1_Intrm Reminder Call.doc	IC Document
AAA.2_Intrm Reminder Call_Spanish.doc AAA.2_Intrm Reminder Call_Spanish.doc	IC Document
BBB.1_Intrm ThankU.doc BBB.1_Intrm ThankU.doc	IC Document
BBB.2_Intrm ThankU_Spanish.docx BBB.2_Intrm ThankU_Spanish.docx	IC Document
CCC.1_Final Adv Letter.docx CCC.1_Final Adv Letter.docx	IC Document
CCC.2_Final Adv Letter_Spanish.docx CCC.2_Final Adv Letter_Spanish.docx	IC Document
EEE.1_Final Postcard.docx EEE.1_Final Postcard.docx	IC Document
EEE.2_Final Postcard_Spanish.docx EEE.2_Final Postcard_Spanish.docx	IC Document
FFF.1_Final Reminder Email.docx FFF.1_Final Reminder Email.docx	IC Document
FFF.2_Final Reminder Email_Spanish.docx FFF.2_Final Reminder Email_Spanish	IC Document
HHH.1_Final Reminder Call.docx HHH.1_Final Reminder Call.docx	IC Document
HHH.2_Final Reminder Call_Spanish.docx HHH.2_Final Reminder Call_Spanish.docx	IC Document
III.1_Final ThankU.docx III.1_Final ThankU.docx	IC Document
III.2_Final ThankU_Spanish.docx III.2_Final ThankU_Spanish.docx	IC Document
KKK.1_FG Flyer Mailing_REV.docx KKK.1_FG Flyer Mailing.docx	IC Document
KKK.2_FG Flyer Mailing_Spanish.docx KKK.2_FG Flyer Mailing_Spanish.docx	IC Document
LLL.1_FG Call-in Script.docx LLL.1_FG Call-in Script.docx	IC Document
LLL.2_FG Call-in Script_Spanish.docx LLL.2_FG Call-in Script_Spanish.docx	IC Document
MMM.1_FG Recruit Script.docx MMM.1_FG Recruit Script.docx	IC Document
MMM.2_FG Recruit Script_Spanish.docx MMM.2_FG Recruit Script_Spanish.docx	IC Document
NNN.1_FG Reminder Call.docx NNN.1_FG Reminder Call.docx	IC Document
NNN.2_FG Reminder Call_Spanish.docx NNN.2_FG Reminder Call_Spanish.docx	IC Document
RR.1_Base Postcard.docx RR.1_Base Postcard.docx	IC Document
RR.2_Base Postcard_Spanish.docx RR.2_Base Postcard_Spanish.docx	IC Document
SS.1_Base Remind Script.docx SS.1_Base Remind Script.docx	IC Document
SS.2_Base Remind Script_Spanish.docx SS.2_Base Remind Script_Spanish.docx	IC Document
TT.1_Base ThankU.docx TT.1_Base ThankU.docx	IC Document
TT.2_Base ThankU_Spanish.docx TT.2_Base ThankU_Spanish.docx	IC Document
UU.1_Base Ineligible.docx UU.1_Base Ineligible.docx	IC Document
UU.2_Base Ineligible_Spanish.docx UU.2_Base Ineligible_Spanish.docx	IC Document
VV.1_Intrm Adv Letter.docx VV.1_Intrm Adv Letter.docx	IC Document
VV.2_Intrm Adv Letter_Spanish.docx VV.2_Intrm Adv Letter_Spanish.docx	IC Document
X.1_Part Adv Flyer.doc X.1_Part Adv Flyer.doc	IC Document
X.2_Part Adv Flyer_Spanish.doc X.2_Part Adv Flyer_Spanish.doc	IC Document
XX.1_Intrm Postcard.docx XX.1_Intrm Postcard.docx	IC Document
XX.2_Intrm Postcard_Spanish.docx XX.2_Intrm Postcard_Spanish.docx	IC Document
Y.1_Part Flyer.docx Y.1_Part Flyer.docx	IC Document
Y.2_Part Flyer_Spanish.docx Y.2_Part Flyer_Spanish.docx	IC Document
YY.1_Intrm Reminder Email.docx YY.1_Intrm Reminder Email.docx	IC Document
YY.2_Intrm Reminder Email_Spanish.docx YY.2_Intrm Reminder Email_Spanish.docx	IC Document
Z.1_Part Fact Sheet_English.docx Z.1_Part Fact Sheet_English.docx	IC Document
Z.2_Part Fact Sheet_Spanish.doc Z.2_Part Fact Sheet_Spanish.doc	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

WIC NE Individuals/Household - Phase II

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-KK.1_Child_Final PAPI EnglishEdited.doc	KK.1_Child_Final PAPI EnglishEdited.doc	No		Paper Only
Other-KK.2_Child_Final PAPI Spanish.doc	KK.2_Child_Final PAPI Spanish.doc	No		Paper Only
Other-PP.1_Postpartum_Final CATI English.docx	PP.1_Postpartum_Final CATI English.docx	Yes	Yes	Fillable Fileable
Other-PP.2_Postpartum_Final CATI Spanish.docx	PP.2_Postpartum_Final CATI Spanish.docx	Yes	Yes	Fillable Fileable
Other-QQ.1_Child_Final CATI English.doc	QQ.1_Child_Final CATI English.doc	Yes	Yes	Fillable Fileable
Other-QQ.2_Child_Final CATI Spanish.doc	QQ.2_Child_Final CATI Spanish.doc	Yes	Yes	Fillable Fileable
Other-JJJ.1_FG Mod Guide_English.doc	JJJ.1_FG Mod Guide_English.doc	No		Paper Only
Other-JJJ.2-FS Mod Guide_Spanish.docx	JJJ.2-FS Mod Guide_Spanish..docx	No		Paper Only
Other-AA.1_Part Screener	AA.1_Part Screener.doc	Yes	Yes	Fillable Fileable
Other-OO.1_Pregnant_Final CATI English.docx	OO.1_Pregnant_Final CATI English.docx	Yes	Yes	Fillable Fileable
Other-OO.2_Pregnant_Final CATI Spanish.docx	OO.2_Pregnant_Final CATI Spanish.docx	Yes	Yes	Fillable Fileable
Other-AA.2_Part Screener_Spanish	AA.2_Part Screener_Spanish.doc	Yes	Yes	Fillable Fileable
Other-CC.1_Pregnant_Baseline PAPI English.docx	CC.1_Pregnant_Baseline PAPI English.docx	No		Paper Only
Other-CC.2_Pregnant_Baseline PAPI Spanish.docx	CC.2_Pregnant_Baseline PAPI Spanish.docx	No		Paper Only
Other-DD.1_Postpartum_Baseline PAPI English	DD.1_Postpartum_Baseline PAPI English.docx	No		Paper Only
Other-DD.2_Postpartum_Baseline PAPI Spanish.docx	DD.2_Postpartum_Baseline PAPI Spanish.docx	No		Paper Only
Other-EE.1_Child_Baseline PAPI English.doc	EE.1_Child_Baseline PAPI English.doc	No		Paper Only
Other-EE.2_Child_Baseline PAPI Spanish.doc	EE.2_Child_Baseline PAPI Spanish.doc	No		Paper Only
Other-FF.1_Pregnant_Interim PAPI English.docx	FF.1_Pregnant_Interim PAPI English.docx	No		Paper Only
Other-FF.2_Pregnant_Interim PAPI Spanish.docx	FF.2_Pregnant_Interim PAPI Spanish.docx	No		Paper Only
Other-GG.1_Postpartum_Interim PAPI English.docx	GG.1_Postpartum_Interim PAPI English.docx	No		Paper Only
Other-GG.2_Postpartum_Interim PAPI Spanish.docx	GG.2_Postpartum_Interim PAPI Spanish.docx	No		Paper Only
Other-HH.1_Child_Interim PAPI English.doc	HH.1_Child_Interim PAPI English.doc	No		Paper Only
Other-HH.2_Child_Interim PAPI Spanish.doc	HH.2_Child_Interim PAPI Spanish.doc	No		Paper Only
Other-LL.1_Pregnant_Interim CATI English.docx	LL.1_Pregnant_Interim CATI English.docx	Yes	Yes	Fillable Fileable
Other-LL.2_Pregnant_Interim CATI Spanish.docx	LL.2_Pregnant_Interim CATI Spanish.docx	Yes	Yes	Fillable Fileable
Other-MM.1_Postpartum_Interim CATI English.docx	MM.1_Postpartum_Interim CATI English.docx	Yes	Yes	Fillable Fileable
Other-MM.2_Postpartum_Interim CATI Spanish.docx	MM.2_Postpartum_Interim CATI Spanish.docx	Yes	Yes	Fillable Fileable
Other-JJ.2_Postpartum_Final PAPI Spanish.docx	JJ.2_Postpartum_Final PAPI Spanish.docx	No		Paper Only
Other-NN.1_Child_Interim CATI English.doc	NN.1_Child_Interim CATI English.doc	Yes	Yes	Fillable Fileable
Other-NN.2_Child_Interim CATI Spanish.doc	NN.2_Child_Interim CATI Spanish.doc	Yes	Yes	Fillable Fileable
Other-II.1_Pregnant_Final PAPI English.docx	II.1_Pregnant_Final PAPI English.docx	No		Paper Only
Other-II.2_Pregnant_Final PAPI Spanish.docx	II.2_Pregnant_Final PAPI Spanish.docx	No		Paper Only
Other-JJ.1_Postpartum_Final PAPI English.docx	JJ.1_Postpartum_Final PAPI English.docx	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 FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 900

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 83 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,259	4,259
Annual IC Time Burden (Hours)	472	472
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
BB.1_Part Consent.docx	BB.1_Part Consent.docx	07/22/2014
BB.2_Part Consent_Spanish.docx	BB.2_Part Consent_Spanish.docx	07/22/2014
WW.1_Intrm Cov Letter.docx	WW.1_Intrm Cov Letter.docx	07/22/2014
WW.2_Intrm Cov Letter_Spanish.docx	WW.2_Intrm Cov Letter_Spanish.docx	07/22/2014
ZZ.1_Intrm Cov Letter 2.docx	ZZ.1_Intrm Cov Letter 2.docx	07/22/2014
ZZ.2_Intrm Cov Letter 2_Spanish.doc	ZZ.2_Intrm Cov Letter 2_Spanish_.doc	07/22/2014
DDD.1_Final Cov Letter.docx	DDD.1_Final Cov Letter.docx	07/22/2014
DDD.2_Final Cov Letter_Spanish.docx	DDD.2_Final Cov Letter_Spanish.docx	07/22/2014
GGG.1_Final Cov Letter 2.docx	GGG.1_Final Cov Letter 2.docx	07/22/2014
GGG.2_Final Cov Letter 2_Spanish.docx	GGG.2_Final Cov Letter 2_Spanish.docx	07/22/2014
OOO.1_FG Consent.docx	OOO.1_FG Consent.docx	07/22/2014
OOO.2_FG_Consent_Spanish.docx	OOO.2_FG_Consent_Spanish.docx	07/22/2014
AAA.1_Intrm Reminder Call.doc	AAA.1_Intrm Reminder Call.doc	07/22/2014
AAA.2_Intrm Reminder Call_Spanish.doc	AAA.2_Intrm Reminder Call_Spanish.doc	07/22/2014
BBB.1_Intrm ThankU.doc	BBB.1_Intrm ThankU.doc	07/22/2014
BBB.2_Intrm ThankU_Spanish.docx	BBB.2_Intrm ThankU_Spanish.docx	07/22/2014
CCC.1_Final Adv Letter.docx	CCC.1_Final Adv Letter.docx	07/22/2014
CCC.2_Final Adv Letter_Spanish.docx	CCC.2_Final Adv Letter_Spanish.docx	07/22/2014
EEE.1_Final Postcard.docx	EEE.1_Final Postcard.docx	07/22/2014
EEE.2_Final Postcard_Spanish.docx	EEE.2_Final Postcard_Spanish.docx	07/22/2014
FFF.1_Final Reminder Email.docx	FFF.1_Final Reminder Email.docx	07/22/2014
FFF.2_Final Reminder Email_Spanish	FFF.2_Final Reminder Email_Spanish.docx	07/22/2014
HHH.1_Final Reminder Call.docx	HHH.1_Final Reminder Call.docx	07/22/2014
HHH.2_Final Reminder Call_Spanish.docx	HHH.2_Final Reminder Call_Spanish.docx	07/22/2014
III.1_Final ThankU.docx	III.1_Final ThankU.docx	07/22/2014
III.2_Final ThankU_Spanish.docx	III.2_Final ThankU_Spanish.docx	07/22/2014
KKK.1_FG Flyer Mailing.docx	KKK.1_FG Flyer Mailing_REV.docx	07/22/2014
KKK.2_FG Flyer Mailing_Spanish.docx	KKK.2_FG Flyer Mailing_Spanish.docx	07/22/2014
LLL.1_FG Call-in Script.docx	LLL.1_FG Call-in Script.docx	07/22/2014
LLL.2_FG Call-in Script_Spanish.docx	LLL.2_FG Call-in Script_Spanish.docx	07/22/2014
MMM.1_FG Recruit Script.docx	MMM.1_FG Recruit Script.docx	07/22/2014
MMM.2_FG Recruit Script_Spanish.docx	MMM.2_FG Recruit Script_Spanish.docx	07/22/2014
NNN.1_FG Reminder Call.docx	NNN.1_FG Reminder Call.docx	07/22/2014
NNN.2_FG Reminder Call_Spanish.docx	NNN.2_FG Reminder Call_Spanish.docx	07/22/2014
RR.1_Base Postcard.docx	RR.1_Base Postcard.docx	07/22/2014
RR.2_Base Postcard_Spanish.docx	RR.2_Base Postcard_Spanish.docx	07/22/2014
SS.1_Base Remind Script.docx	SS.1_Base Remind Script.docx	07/22/2014
SS.2_Base Remind Script_Spanish.docx	SS.2_Base Remind Script_Spanish.docx	07/22/2014
TT.1_Base ThankU.docx	TT.1_Base ThankU.docx	07/22/2014
TT.2_Base ThankU_Spanish.docx	TT.2_Base ThankU_Spanish.docx	07/22/2014
UU.1_Base Ineligible.docx	UU.1_Base Ineligible.docx	06/28/2014
UU.2_Base Ineligible_Spanish.docx	UU.2_Base Ineligible_Spanish.docx	06/28/2014
VV.1_Intrm Adv Letter.docx	VV.1_Intrm Adv Letter.docx	07/22/2014
VV.2_Intrm Adv Letter_Spanish.docx	VV.2_Intrm Adv Letter_Spanish.docx	07/22/2014
X.1_Part Adv Flyer.doc	X.1_Part Adv Flyer.doc	07/22/2014
X.2_Part Adv Flyer_Spanish.doc	X.2_Part Adv Flyer_Spanish.doc	07/22/2014
XX.1_Intrm Postcard.docx	XX.1_Intrm Postcard.docx	07/22/2014
XX.2_Intrm Postcard_Spanish.docx	XX.2_Intrm Postcard_Spanish.docx	07/22/2014
Y.1_Part Flyer.docx	Y.1_Part Flyer.docx	07/22/2014
Y.2_Part Flyer_Spanish.docx	Y.2_Part Flyer_Spanish.docx	07/22/2014
YY.1_Intrm Reminder Email.docx	YY.1_Intrm Reminder Email.docx	07/22/2014
YY.2_Intrm Reminder Email_Spanish.docx	YY.2_Intrm Reminder Email_Spanish.docx	07/22/2014
Z.1_Part Fact Sheet_English.docx	Z.1_Part Fact Sheet_English.docx	07/22/2014
Z.2_Part Fact Sheet_Spanish.doc	Z.2_Part Fact Sheet_Spanish.doc	07/22/2014

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