App_S Study Extension Site HT-WT Request Attachment PRAO recommendations 11-12-14CMRev

A

OMB Approval No.: 0584-0580

Approval Expires: XX/XX/20XX

PPENDIX S

AGE 3 EXTENSION WIC INFANT AND TODDLER FEEDING PRATICES STUDY - II

HT/WT REQUEST ATTACHMENT TO WIC SITES

Attachment A

SITE NAME: [Local Agency Name - Site Name]

During the extension period for the Feeding My Baby study, WIC sites will be asked to conduct weight and height measurements for children who are enrolled in the study, but no longer enrolled in the WIC Program. These measurements will be taken near the time of the third birthday, beginning in April 2016 when the children in study start to reach age three. Details for this activity are provided below.

Westat Roles and Responsibilities

1. On behalf of Food and Nutrition Service, Westat Study Liaisons will advise the parent/caregiver that weight and height measurements are needed for the child and that these will be conducted at no cost to the parent/caregiver at the WIC site. The Study Liaison will provide the parent with a timeframe during which the measurements need to be taken and the name, address and phone number of the WIC site with instruction to call the site regarding a date/time to bring the child to the site for measurements.

2. In January 2016, Westat will provide the WIC site with a list of children enrolled in the study and the time period around the third birthday when the measurements are needed. WIC staff can use this list to confirm that a parent/caregiver contacting the site regarding the measurements is enrolled in the study and to provide them with a date/time for the measurements during the appropriate time period.

3. Westat will provide [insert either individual forms or a spreadsheet based on preference of site] for recording the measurements and returning the information to Westat.

4. As a token of appreciation, Westat will provide a $20 incentive plus $10 transportation cost reimbursement to the parent/caregiver upon completion of the measurements.

5. Westat will provide a grant in the amount of [insert $amount] to the WIC site for costs associated with conducting these measurements for children who are not enrolled in WIC. The grant will be sent to [insert name and address] during the month of [insert MM\YYYY].

WIC Site Roles and Responsibilities

1. The site will provide Westat with a phone number to give to the parents/guardians for contacting the site regarding the measurements. If there is a change in the number during the course of the study, the site will notify the Westat Study Liaison of the new number.

2. The site staff will respond to calls from parents/caregivers and provide them with a date/time for the measurements during the appropriate time period identified by Westat on the list of children in the study.

3. The site staff will conduct the measurements and record the results and the date of the measurements on the document provided by Westat.

4. By the end of every month, the site staff will send measurement data collected during that month to Westat. This can be sent via fax at [insert fax number] or mailed to [insert Westat name and address]. If no measurements were conducted during that month, the site staff will inform the Westat Deputy Operations Director by email or phone that there is no measurement data to submit.

Updating Contact Information

On behalf of FNS, Westat Study Liaisons handle all communication with parents/caregivers regarding the study and use multiple strategies to keep in contact with them. When other strategies are unsuccessful, the Study Liaison will request assistance from the WIC staff if the information available to the Liaison indicates the child is still a WIC participant. The requested assistance may include:

• Sharing the contact information Westat has and asking the site staff to compare it to the information they have for the parent/caregiver to determine if the site’s information is more recent.

• Obtaining the updated contact information.

• Asking site staff to make a notation in their records to ask the parent/caregiver at their next visit to contact the Study Liaison.

• Providing a letter for the site staff to mail to the parent/caretaker.

Study Points-of-Contact

The Westat Deputy Operations Director is: Bibi Gollapudi

The Westat Study Liaison is: [Insert name and contact information]

The WIC Site Study Contact is: [insert name and contact information]

Westat will inform the Site Study Contact if there is a change in the Study Liaison. The WIC site will inform the Study Liaison if there is a change in the Site Study Contact.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB number.  The valid OMB control number for this information collection is 0584-XXXX.  The time required to complete this information collection is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.