Information Collection

NSWP III (IC 2 of 2)

IC 223605 under ICR 201503-0584-004 · OMB 0584-0606.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0606 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A3 Revised Certification Survey.docx	Other-Appendix A3 Revised Certificat
Appendix A4 Revised Denied Applicant Survey.docx	Other-Appendix A4 Revised Denied App
Appendix A5 Revised Program Experiences Survey.docx	Other-Appendix A5 Revised Program Ex
Appendix A6 Former WIC Participant Case Study Interview Guide.docx	Other-NSWP-III Pretesting\I-H\Append
C1. Proposed Informed Consent Form Certification Survey.docx	Other-Consent Form
C2. Proposed Informed Consent Form Denied Applicant Survey.docx	Other-Dinied Applicant Consent Form
Generic 0584-0606_Pretesting for NSWP3 8-5-16.docx OMB Memo - NSWP III Pre-testing	IC Document

IC Title:

NSWP III (IC 2 of 2)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Consent Form	C1. Proposed Informed Consent Form Certification Survey.docx	No	Paper Only
Other-Dinied Applicant Consent Form	C2. Proposed Informed Consent Form Denied Applicant Survey.docx	No	Paper Only
Other-Appendix A3 Revised Certification Survey	Appendix A3 Revised Certification Survey.docx	No	Paper Only
Other-Appendix A4 Revised Denied Applicant Survey	Appendix A4 Revised Denied Applicant Survey.docx	No	Paper Only
Other-Appendix A5 Revised Program Experiences Survey	Appendix A5 Revised Program Experiences Survey.docx	No	Paper Only
Other-NSWP-III Pretesting\I-H\Appendix A6 Former WIC Participant Case Study Interview Guide	Appendix A6 Former WIC Participant Case Study Interview Guide.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,032	2,032
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB Memo - NSWP III Pre-testing	Generic 0584-0606_Pretesting for NSWP3 8-5-16.docx	09/20/2016

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