WIC Federal and State Agreement

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FNS 339 WIC Federal and State Agreement	Form and Instruction	Modified	Available
Justification for Change_FNS-339 (12-20-2016).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-01-09	Available
Final FNS-339 Supporting Statement OCIO recommendations 11-3-15.docx	Supporting Statement A	Uploaded 2015-11-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43553	WIC Federal and State Agreement	Form and Instruction	Modified

ICR Details

OMB Control No: 0584-0332	ICR Reference No: 201701-0584-001
Status: Historical Active	Previous ICR Reference No: 201510-0584-001
Agency/Subagency: USDA/FNS	Agency Tracking No:
Title: WIC Federal and State Agreement
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/09/2017
	Date Received in OIRA: 01/09/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	02/28/2019	02/28/2019
Responses	124	0	124
Time Burden (Hours)	31	0	31
Cost Burden (Dollars)	0	0	0

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Abstract: To release funds to the State Agencies to operate the Women, Infant, and Children (WIC), Farmers Market Nutrition Program (FMNP) and the Senior Farmers Market Nutritiion Program (SFMP) through a contract agreement.

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Authorizing Statute(s): PL: Pub.L. 108 - 265 17 Name of Law: Chil Nutrition And WIC Reauthorization Act of 2004
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 43705	07/23/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 68496	11/05/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
WIC Federal and State Agreement	FNS 339	Federal State Supplemental Nutrition Programs Agreement

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	124	124	0	0	0	0
Annual Time Burden (Hours)	31	31	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a revision of a currently approved collection. The current burden inventory is 36 burden hours. The revised estimate for this collection is 31 hours; which decreased the burden by (-5) hours. This decrease is a result of program adjustment due to miscalculations. In our previous estimations, an incorrect calculation was made regarding the number of respondents completing the FNS-339 form. This form contains a checkbox for the Program(s) being submitted and a signature line for the authorizing official’s signature. The previous estimate had counted one respondent per Program. Once it was identified that one respondent could sign for multiple programs, the estimate was recalculated and is now correct. There is also program adjustments due to the number of respondents participating which increased from 142 to 188, an increase of eighteen (46) respondents

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Annual Cost to Federal Government: $1,395

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/09/2017

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