Information Collection

WIC Participant

IC 203577 under ICR 201408-0584-007 · OMB 0584-0580.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
App_A.1.Pretest 30 month 14-1028 - English.docx Other-App_A.1.Pretest 30 month 14-10
App_A.2.Pretest 30 month 14-1028 - Spanish.docx Other-App_A.2.Pretest 30 month 14-10
App_C 1 Extension Study Consent_Contact - English PRAO recommendations 11-12-14CMRev.docx Other-App_C 1 Extension Study Consen
App_C 2 Extension Study Consent_Contact - Spanish PRAO recommendations 11-14-14CMRev.docx Other-App_C 2 Extension Study Consen
App_D 1.V2.24 Month Revised Interview - English 100914.docx Other-App_D 1.V2.24 Month Revised In
App_D.2.V2.24 Month Revised Interview-Spanish 100914.docx Other-App_D.2.V2.24 Month Revised In
App_E.1.ContactInformationForm-English.docx Other-App_E.1.ContactInformationForm
App_E.2.ContactInformationForm-Spanish.docx Other-App_E.2.ContactInformationForm
App_G.1.30 month 14-1028 - English.docx Other-App G1.30-month interview
App_G.2.30 month 14-1028 - Spanish.docx Other-App_G.2.30 month Interview - S
App_J.1.36 month 14-1028 - English.docx Other-App_J.1.36 month Interview 14-
App_J.2.36 month 14-1028 - Spanish.docx Other-App_J.2.36 month Interview 14-
App_V.1.HT_WT.MeasurementCard-English-2.docx Other-App_V.1.HT_WT.MeasurementCard-
App_V.2.HT_WT.MeasurementCard-Spanish-2.docx Other-App_V.2.HT_WT.MeasurementCard-
App_W.1.HIPAA Letter and Form - English PRAO recommendations 11-12-14.docx Other-App_W.1.HIPAA Letter and Form
App_W.2.HIPAA Letter and Form - Spanish PRAO recommendations 11-14-14.docx Other-App_W.2.HIPAA Letter and Form
App_B.1.41904_FeedingBabyFlyer-Eng PRAO recommendations 11-10-14.docx
App_B.1.41904_FeedingBabyFlyer-Eng PRAO recommendations 11-10-14
IC Document
App_B.2.41904_FeedingBabyFlyer-Span PRAO recommendations 11-14-14.docx
App_B.1.41904_FeedingBabyFlyer-Span PRAO recommendations 11-14-14
IC Document
App_F.1.V2.30monthadvanceletter - English PRAO recommendations 11-10-14.docx
App_F.1.V2.30monthadvanceletter - English PRAO recommendations 11-10-14
IC Document
App_F.2.V2.30monthadvanceletter - Spanish PRAO recommendations 11-14-14.docx
App_F.2.V2.30monthadvanceletter - Spanish PRAO recommendations 11-14-14
IC Document
App_H 1 ReminderScripts-English PRAO recommendations 11-12-14 V2.docx
App_H.1.ReminderScripts-English PRAO recommendations 11-12-14
IC Document
App_H.2.Reminder Scripts-Spanish-sm.docx
App_H.2.ReminderScripts-Spanish PRAO recommendations 11-14-14
IC Document
App_I.1.36monthadvanceletter - English PRAO recommendations 11-12-14.docx
App_I.1.36monthadvanceletter - English PRAO recommendations 11-12-14
IC Document
App_I.2.36monthadvanceletter - Spanish PRAO recommendations 11-14-14.docx
App_I.2.36monthadvanceletter - Spanish PRAO recommendations 11-14-14
IC Document
App_K.1.Birthday Card-English.docx
App_K.1.Birthday Card-English
IC Document
App_J.2.36 month 14-1028 - Spanish.docx
App_J.2.36 month 14-1028 - Spanish
IC Document
App_U.1.HT_WT.RespondentLetter-English PRAO recommendations 11-12-014.docx
App_U.1.HT_WT.RespondentLetter-English PRAO recommendations 11-12-014
IC Document
App_U.2.HT_WT.RespondentLetter-Spanish PRAO recommendations 11-14-14.docx
App_U.2.HT_WT.RespondentLetter-Spanish PRAO recommendations 11-14-14
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-App_A.1.Pretest 30 month 14-1028 - English No   Paper Only
Other-App_A.2.Pretest 30 month 14-1028 - Spanish No   Paper Only
Other-App_C 1 Extension Study Consent_Contact - English PRAO recommendations No   Paper Only
Other-App_C 2 Extension Study Consent_Contact - Spanish PRAO recommendations No   Paper Only
Other-App_D 1.V2.24 Month Revised Interview - English No   Paper Only
Other-App_D.2.V2.24 Month Revised Interview-Spanish No   Paper Only
Other-App_E.1.ContactInformationForm-English No   Paper Only
Other-App_E.2.ContactInformationForm-Spanish No   Paper Only
Other-App G1.30-month interview No   Paper Only
Other-App_G.2.30 month Interview - Spanish No   Paper Only
Other-App_J.1.36 month Interview 14-1028 - English No   Paper Only
Other-App_J.2.36 month Interview 14-1028 - Spanish No   Paper Only
Other-App_V.1.HT_WT.MeasurementCard-English-2 No   Paper Only
Other-App_V.2.HT_WT.MeasurementCard-Spanish-2 No   Paper Only
Other-App_W.1.HIPAA Letter and Form - English PRAO recommendations 11-12-14 No   Paper Only
Other-App_W.2.HIPAA Letter and Form - Spanish PRAO recommendations 11-14-14 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 33,072 0 12,517 0 0 20,555
Annual IC Time Burden (Hours) 4,673 0 210 0 0 4,463
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
App_B.1.41904_FeedingBabyFlyer-Eng PRAO recommendations 11-10-14 12/23/2014
App_B.1.41904_FeedingBabyFlyer-Span PRAO recommendations 11-14-14 12/23/2014
App_F.1.V2.30monthadvanceletter - English PRAO recommendations 11-10-14 12/23/2014
App_F.2.V2.30monthadvanceletter - Spanish PRAO recommendations 11-14-14 12/23/2014
App_H.1.ReminderScripts-English PRAO recommendations 11-12-14 02/10/2015
App_H.2.ReminderScripts-Spanish PRAO recommendations 11-14-14 02/10/2015
App_I.1.36monthadvanceletter - English PRAO recommendations 11-12-14 12/23/2014
App_I.2.36monthadvanceletter - Spanish PRAO recommendations 11-14-14 12/23/2014
App_K.1.Birthday Card-English 12/23/2014
App_J.2.36 month 14-1028 - Spanish 12/23/2014
App_U.1.HT_WT.RespondentLetter-English PRAO recommendations 11-12-014 12/23/2014
App_U.2.HT_WT.RespondentLetter-Spanish PRAO recommendations 11-14-14 12/23/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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