| Respondent Category |
Respondent Type |
Instrument |
Appendix ID |
Total Sample Size |
Respondents |
Non-Respondents |
Grand Total Burden Estimate (Hours) |
| Estimated Number of Respondents |
Frequency of Response |
Total Annual Responses |
Average Time Per Response (Hours) |
Total Annual Burden Estimate (Hours) |
Estimated Number of Non-Respondents |
Frequency of Non-Response |
Total Annual Non-Responses |
Average Time Per Non- Response (Hours) |
Total Annual Burden Estimate (Hours) |
| State, Local, and Tribal Government |
| State, Local, and Tribal Government |
State WIC Agency Directors |
State Agency Survey-Paper |
A1 |
9 |
9 |
1 |
9 |
1.15 |
10.35 |
0 |
0 |
0 |
0.00 |
0.00 |
10.35 |
| Debriefing Interview |
D1 |
9 |
9 |
1 |
9 |
0.33 |
2.97 |
0 |
0 |
0 |
0.00 |
0.00 |
2.97 |
| Letter to State Agencies from Regional Offices |
B2 |
9 |
9 |
1 |
9 |
0.02 |
0.18 |
0 |
0 |
0 |
0.00 |
0.00 |
0.18 |
| State Agency Survey Invitation Email |
B3 |
9 |
9 |
1 |
9 |
0.05 |
0.45 |
0 |
1 |
0 |
0.02 |
0.00 |
0.45 |
| State Agency Survey Invitation Letter with Instrument |
B4 |
9 |
9 |
1 |
9 |
0.07 |
0.63 |
0 |
1 |
0 |
0.02 |
0.00 |
0.63 |
| State Agency Survey Reminder Email, 1 |
B5 |
9 |
5 |
1 |
5 |
0.05 |
0.23 |
5 |
1 |
5 |
0.02 |
0.09 |
0.32 |
| State Agency Survey Reminder Email, 2 |
5 |
2 |
1 |
2 |
0.05 |
0.10 |
2 |
1 |
2 |
0.02 |
0.05 |
0.15 |
| State Agency Survey Reminder Email, 3 |
2 |
1 |
1 |
1 |
0.05 |
0.06 |
1 |
1 |
1 |
0.02 |
0.03 |
0.08 |
| State Agency Survey Reminder Email, 4 |
1 |
1 |
1 |
1 |
0.05 |
0.03 |
1 |
1 |
1 |
0.02 |
0.01 |
0.05 |
| State Agency Survey Reminder Phone Script |
B6 |
9 |
9 |
1 |
9 |
0.08 |
0.72 |
4 |
1 |
4 |
0.02 |
0.08 |
0.80 |
| State Agency Survey Thank You Letter |
C3 |
9 |
9 |
1 |
9 |
0.02 |
0.18 |
0 |
0 |
0 |
0.00 |
0.00 |
0.18 |
| Local WIC Agency Directors |
Local WIC Agency Survey-Paper |
A2 |
Amy Wieczorek, MPH:
Each SA provides 1-2 LA contacts
18 |
9 |
1 |
9 |
0.72 |
6.45 |
9 |
0 |
0 |
0.00 |
0.00 |
6.45 |
| Debriefing Interview |
D2 |
9 |
9 |
1 |
9 |
0.33 |
2.97 |
0 |
0 |
0 |
0.00 |
0.00 |
2.97 |
| Local WIC Agency Survey Invitation Email |
B7 |
18 |
9 |
1 |
9 |
0.05 |
0.45 |
9 |
1 |
9 |
0.02 |
0.18 |
0.63 |
| Local WIC Agency Survey Invitation Letter with Instrument |
B8 |
18 |
9 |
1 |
9 |
0.07 |
0.63 |
9 |
1 |
9 |
0.02 |
0.18 |
0.81 |
| Local WIC Agency Survey Reminder Email, 1 |
B9 |
9 |
3 |
1 |
3 |
0.05 |
0.17 |
6 |
1 |
6 |
0.02 |
0.11 |
0.28 |
| Local WIC Agency Survey Reminder Email, 2 |
6 |
2 |
1 |
2 |
0.05 |
0.11 |
3 |
1 |
3 |
0.02 |
0.07 |
0.18 |
| Local WIC Agency Survey Reminder Email, 3 |
3 |
1 |
1 |
1 |
0.05 |
0.04 |
3 |
1 |
3 |
0.02 |
0.05 |
0.10 |
| Local WIC Agency Survey Reminder Email, 4 |
3 |
1 |
1 |
1 |
0.05 |
0.05 |
2 |
1 |
2 |
0.02 |
0.03 |
0.08 |
| Local WIC Agency Survey Reminder Phone Script, Call 1 |
B10 |
18 |
5 |
1 |
5 |
0.08 |
0.43 |
13 |
1 |
0 |
0.02 |
0.00 |
0.43 |
| Local WIC Agency Survey Reminder Phone Script, Call 2 |
13 |
4 |
1 |
4 |
0.08 |
0.30 |
9 |
1 |
0 |
0.02 |
0.00 |
0.30 |
| Local WIC Agency Survey Thank You Letter |
C4 |
9 |
9 |
1 |
9 |
0.02 |
0.18 |
0 |
0 |
0 |
0.00 |
0.00 |
0.18 |
| Subtotal of State, Local, and Tribal Government |
18 |
7 |
133 |
0.21 |
27.68 |
9 |
5 |
44 |
0.02 |
0.89 |
28.56 |
| Individuals or Households |
| Individuals or Households |
Current WIC Program Participants |
Certification Survey-In Person |
A3 |
100 |
9 |
1 |
9 |
0.50 |
4.50 |
91 |
0 |
0 |
0.00 |
0.00 |
4.50 |
| Debriefing Interview |
D3 |
9 |
9 |
1 |
9 |
0.17 |
1.50 |
0 |
0 |
0 |
0.00 |
0.00 |
1.50 |
| Certification Survey Invitation Phone Script, Call 1 |
B11 |
100 |
2 |
1 |
2 |
0.08 |
0.16 |
98 |
1 |
98 |
0.02 |
1.96 |
2.12 |
| Certification Survey Invitation Phone Script, Call 2 |
98 |
2 |
1 |
2 |
0.08 |
0.16 |
96 |
1 |
96 |
0.02 |
1.92 |
2.08 |
| Certification Survey Invitation Phone Script, Call 3 |
96 |
2 |
1 |
2 |
0.08 |
0.15 |
95 |
1 |
95 |
0.02 |
1.90 |
2.05 |
| Certification Survey Invitation Phone Script, Call 4 |
95 |
2 |
1 |
2 |
0.08 |
0.15 |
93 |
1 |
93 |
0.02 |
1.86 |
2.01 |
| Certification Survey Invitation Phone Script, Call 5 |
93 |
1 |
1 |
1 |
0.08 |
0.07 |
92 |
1 |
92 |
0.02 |
1.84 |
1.92 |
| Text Message Reminder for Scheduled Certification Survey |
B12 |
9 |
8 |
1 |
8 |
0.02 |
0.15 |
1 |
1 |
1 |
0.00 |
0.00 |
0.15 |
| Scheduled Certification Survey Reminder Phone Script |
B13 |
93 |
9 |
1 |
9 |
0.08 |
0.72 |
84 |
1 |
84.1 |
0.02 |
1.68 |
2.40 |
| Informed Consent Form-Certification Survey |
C1 |
9 |
9 |
1 |
9 |
0.02 |
0.18 |
0 |
0 |
0 |
0.02 |
0.00 |
0.18 |
| Recently Denied WIC Program Applicants |
Denied Applicant Survey-In Person |
A4 |
100 |
9 |
1 |
9 |
0.58 |
5.25 |
91 |
0 |
0 |
0.00 |
0.00 |
5.25 |
| Debriefing Interview |
D4 |
9 |
9 |
1 |
9 |
0.17 |
1.50 |
0 |
0 |
0 |
0.00 |
0.00 |
1.50 |
| Denied Applicant Survey Invitation Phone Script, Call 1 |
B14 |
100 |
2 |
1 |
2 |
0.08 |
0.16 |
98 |
1 |
98 |
0.02 |
1.96 |
2.12 |
| Denied Applicant Survey Invitation Phone Script, Call 2 |
98 |
2 |
1 |
2 |
0.08 |
0.16 |
96 |
1 |
96 |
0.02 |
1.92 |
2.08 |
| Denied Applicant Survey Invitation Phone Script, Call 3 |
96 |
2 |
1 |
2 |
0.08 |
0.15 |
94 |
1 |
94 |
0.02 |
1.88 |
2.04 |
| Denied Applicant Survey Invitation Phone Script, Call 4 |
94 |
2 |
1 |
2 |
0.08 |
0.15 |
92 |
1 |
92 |
0.02 |
1.84 |
2.00 |
| Denied Applicant Survey Invitation Phone Script, Call 5 |
92 |
1 |
1 |
1 |
0.08 |
0.07 |
91 |
1 |
91 |
0.02 |
1.83 |
1.90 |
| Text Message Reminder for Scheduled Denied Applicant Survey |
B15 |
9 |
8 |
1 |
8 |
0.02 |
0.15 |
1 |
1 |
1 |
0.00 |
0.00 |
0.15 |
| Scheduled Denied Applicant Survey Reminder Phone Script |
B16 |
92 |
9 |
1 |
9 |
0.08 |
0.72 |
83 |
1 |
83 |
0.02 |
1.66 |
2.38 |
| Informed Consent Form-Denied Applicant Survey |
C2 |
9 |
9 |
1 |
9 |
0.02 |
0.18 |
0 |
0 |
0 |
0.02 |
0.00 |
0.18 |
| Current WIC Program Participants |
Program Experiences Survey-Telephone |
A5 |
100 |
9 |
1 |
9 |
0.50 |
4.50 |
91 |
0 |
0 |
0.00 |
0.00 |
4.50 |
| Debriefing Interview |
D5 |
9 |
9 |
1 |
9 |
0.17 |
1.50 |
0 |
0 |
0 |
0.00 |
0.00 |
1.50 |
| Program Experiences Survey Invitation Phone Script, Call 1 |
B17 |
100 |
2 |
1 |
2 |
0.08 |
0.16 |
98 |
1 |
98 |
0.02 |
1.96 |
2.12 |
| Program Experiences Survey Invitation Phone Script, Call 2 |
98 |
2 |
1 |
2 |
0.08 |
0.16 |
96 |
1 |
96 |
0.02 |
1.92 |
2.08 |
| Program Experiences Survey Invitation Phone Script, Call 3 |
96 |
2 |
1 |
2 |
0.08 |
0.15 |
94 |
1 |
94 |
0.02 |
1.88 |
2.04 |
| Program Experiences Survey Invitation Phone Script, Call 4 |
94 |
2 |
1 |
2 |
0.08 |
0.15 |
92 |
1 |
92 |
0.02 |
1.84 |
2.00 |
| Program Experiences Survey Invitation Phone Script, Call 5 |
92 |
1 |
1 |
1 |
0.08 |
0.07 |
91 |
1 |
91 |
0.02 |
1.83 |
1.90 |
| Former WIC Program Participants |
Former WIC Participant Interview Guide-Telephone |
A6 |
100 |
9 |
1 |
9 |
0.67 |
6.00 |
91 |
0 |
0 |
0.00 |
0.00 |
6.00 |
| Debriefing Interview |
D6 |
9 |
9 |
1 |
9 |
0.17 |
1.50 |
0 |
0 |
0 |
0.00 |
0.00 |
1.50 |
| Former WIC Participant Survey Invitation Phone Script, Call 1 |
B18 |
100 |
2 |
1 |
2 |
0.08 |
0.16 |
98 |
1 |
98 |
0.02 |
1.96 |
2.12 |
| Former WIC Participant Survey Invitation Phone Script, Call 2 |
98 |
2 |
1 |
2 |
0.08 |
0.16 |
96 |
1 |
96 |
0.02 |
1.92 |
2.08 |
| Former WIC Participant Survey Invitation Phone Script, Call 3 |
96 |
2 |
1 |
2 |
0.08 |
0.15 |
94 |
1 |
94 |
0.02 |
1.88 |
2.04 |
| Former WIC Participant Survey Invitation Phone Script, Call 4 |
94 |
2 |
1 |
2 |
0.08 |
0.15 |
92 |
1 |
92 |
0.02 |
1.84 |
2.00 |
| Former WIC Participant Survey Invitation Phone Script, Call 5 |
92 |
1 |
1 |
1 |
0.08 |
0.07 |
91 |
1 |
91 |
0.02 |
1.83 |
1.90 |
| Subtotal of Individuals or Households |
36 |
4 |
158 |
0.20 |
31.15 |
364 |
6 |
2059 |
0.02 |
41.14 |
72.29 |
| Grand Total |
54 |
5 |
291 |
0.20 |
58.83 |
373 |
6 |
2104 |
0.02 |
42.02 |
100.85 |
| Note: Appendix B1 is a letter to FNS Regional Offices, therefore, it is not included as burden in the table. |
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