Information Collection

State WIC Agency Officials (2016 and 2018)

IC 219981 under ICR 201601-0584-006 · OMB 0584-0609.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0609 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix G nutritional risk worksheet sample 12.14.15.pdf	Other-Appendix G Nutritional Risk Wo
Appendix K Data Transmittal Worksheet Final 1.8.16.docx	Other-Appendix K Data Transmittal Wo
Appendix E wic omb guidance cover letter 12.14.15.docx Appendix E Cover Letter for Guidance to WIC State Agencies Providing Participant Data	IC Document
Appendix F wic omb guidance 1.5.16.docx Appendix F Guidance for WIC State Agencies Providing Participant Data	IC Document
Appendix H sample reminder email to states 12.14.15.docx Appendix H Sample Reminder Email to WIC State Agencies	IC Document
Appendix I sample follow-up email to states 12.14.15.docx Appendix I Sample Follow-up Email to WIC State Agencies	IC Document

IC Title:

State WIC Agency Officials (2016 and 2018)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 246.7(e)(4) 7 CFR 246.25(b)(3)

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-Appendix G Nutritional Risk Worksheet			Appendix G nutritional risk worksheet sample 12.14.15.pdf		No		Paper Only
Other-Appendix K Data Transmittal Worksheet			Appendix K Data Transmittal Worksheet Final 1.8.16.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-8 USDA/FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 94 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	852	852
Annual IC Time Burden (Hours)	530	530
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix E Cover Letter for Guidance to WIC State Agencies Providing Participant Data	Appendix E wic omb guidance cover letter 12.14.15.docx	02/03/2016
Appendix F Guidance for WIC State Agencies Providing Participant Data	Appendix F wic omb guidance 1.5.16.docx	02/03/2016
Appendix H Sample Reminder Email to WIC State Agencies	Appendix H sample reminder email to states 12.14.15.docx	02/03/2016
Appendix I Sample Follow-up Email to WIC State Agencies	Appendix I sample follow-up email to states 12.14.15.docx	02/03/2016

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