Information Collection

State, Local, or Tribal Government (WIC Directors and Database Administrators)

IC 224821 under ICR 201611-0584-002 · OMB 0584-0627.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
A.4_WIC SA Interview Instrument_FINAL.docx	Other-Appendix A.4 WIC State Agency
B.2_Agenda for Conference Call WIC SA Dec 2016.docx	Other-Appendix B.2 Agenda for Confer
C.1_Administrative Costs of Cost Containment Practices.xlsx	Other-Appendix C.1 Administrative Co
D.1_Certification Data Request and Instructions_Participants_FINAL.docx	Other-Appendix D.1 Instruction Sheet
D.3_Sample Follow-Up Email for Participant Certification Data Dec 16.docx	Other-Appendix D.3 Sample Follow-up
D.4_FTP Site Instructions for State Agency Data Files Dec 2016.docx	Other-Appendix D.4 FTP Site Instruct
E.1_Certification Data Request and Instructions_Former_FINAL.docx	Other-Appendix E.1 Instruction Sheet
E.3_Sample Follow-Up Email for Former Participant Cert Data Dec 16.docx	Other-Appendix E.3 Sample Follow-Up
F.1_EBT Data Submission Request and Instructions_FINAL.docx	Other-Appendix F.1 Instruction Sheet
F.3_Sample Follow-Up Email for EBT Data Dec 2016.docx	Other-Appendix F.3 Sample Follow-Up
A.1_WIC SA Census Advance Letter_FINAL.docx Appendix A.1 WIC State Agency (58) Advance Letter	IC Document
A.2_Cost Containment Study FAQs_FINAL.docx Appendix A.2 Study of WIC Food Package Costs and Cost Containment Study Information Sheet	IC Document
A.3_Summary of WIC SA Cost Containment_FINAL.docx Appendix A.3 Summary of Cost-Containment Practices	IC Document
B.1_WIC SA EBT State Advance Letter_FINAL.docx Appendix B.1 WIC State Agency EBT (12) Advance Letter	IC Document
D.2_Sample Reminder Email for Participant Certification Data.docx Appendix D.2 Sample Reminder Email for WIC Participant Certification Data	IC Document
E.2_Sample Reminder Email for Former Participant Cert Data.docx Appendix E.2 Sample Reminder Email for Former WIC Certification Data	IC Document
F.2_Sample Reminder Email for EBT Data.docx Appendix F.2 Sample Reminder Email for WIC EBT Data Request	IC Document
A.5_Spreadsheet of WIC SA Cost Containment Practices_FINAL.pdf Appendix A.5 Spreadsheet of WIC State Agency Cost Containment Practices	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State, Local, or Tribal Government (WIC Directors and Database Administrators)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix A.4 WIC State Agency Semi-Structured Interview Instrument	A.4_WIC SA Interview Instrument_FINAL.docx	No		Paper Only
Other-Appendix E.1 Instruction Sheet for Submitting Former WIC Participants Certification Data File	E.1_Certification Data Request and Instructions_Former_FINAL.docx	Yes	Yes	Fillable Fileable
Other-Appendix B.2 Agenda for Conference Call with WIC State Agencies	B.2_Agenda for Conference Call WIC SA Dec 2016.docx	No		Paper Only
Other-Appendix C.1 Administrative Costs of Cost Containment Practices	C.1_Administrative Costs of Cost Containment Practices.xlsx	Yes	No	Paper Only
Other-Appendix D.3 Sample Follow-up Email for WIC Participant Certification Data	D.3_Sample Follow-Up Email for Participant Certification Data Dec 16.docx	No		Paper Only
Other-Appendix D.4 FTP Site Instructions for State Agencies Submitting Data Files	D.4_FTP Site Instructions for State Agency Data Files Dec 2016.docx	Yes	Yes	Fillable Fileable
Other-Appendix E.3 Sample Follow-Up Email for Former WIC Participant Certification Data	E.3_Sample Follow-Up Email for Former Participant Cert Data Dec 16.docx	No		Paper Only
Other-Appendix F.3 Sample Follow-Up Email for WIC EBT Data Submission	F.3_Sample Follow-Up Email for EBT Data Dec 2016.docx	No		Paper Only
Other-Appendix D.1 Instruction Sheet for Submitting WIC Participant Certification Data Files	D.1_Certification Data Request and Instructions_Participants_FINAL.docx	Yes	Yes	Fillable Fileable
Other-Appendix F.1 Instruction Sheet for Submitting EBT Transaction Data Files	F.1_EBT Data Submission Request and Instructions_FINAL.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: 86

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 17 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	446	446
Annual IC Time Burden (Hours)	215	215
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix A.1 WIC State Agency (58) Advance Letter	A.1_WIC SA Census Advance Letter_FINAL.docx	09/25/2017
Appendix A.2 Study of WIC Food Package Costs and Cost Containment Study Information Sheet	A.2_Cost Containment Study FAQs_FINAL.docx	09/25/2017
Appendix A.3 Summary of Cost-Containment Practices	A.3_Summary of WIC SA Cost Containment_FINAL.docx	09/25/2017
Appendix B.1 WIC State Agency EBT (12) Advance Letter	B.1_WIC SA EBT State Advance Letter_FINAL.docx	09/25/2017
Appendix D.2 Sample Reminder Email for WIC Participant Certification Data	D.2_Sample Reminder Email for Participant Certification Data.docx	12/14/2016
Appendix E.2 Sample Reminder Email for Former WIC Certification Data	E.2_Sample Reminder Email for Former Participant Cert Data.docx	12/16/2016
Appendix F.2 Sample Reminder Email for WIC EBT Data Request	F.2_Sample Reminder Email for EBT Data.docx	12/16/2016
Appendix A.5 Spreadsheet of WIC State Agency Cost Containment Practices	A.5_Spreadsheet of WIC SA Cost Containment Practices_FINAL.pdf	09/25/2017

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