WIC Child Retention (Private Sector) (2 of 2)

Special Nutrition Programs Quick Response Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0613 can be found here:

Documents and Forms

Document Name Document Type
A.3 Pretest-Clinic Staff .docx Other-Pretest - Clinic Staff
A.5 Email Request to WIC Local Agency 20200127.docx Other-Email Request to WIC Local Age
A.7 Reminder Phone Calls to WIC Local Agency 20200127.docx Other-Reminder phone calls to WIC Lo
A.2 Pretest-Local Agency.docx Other-Pretest - Local Agency
A.11 Survey Reminder Phone Calls to Clinic-Level Staff Member 20200127.docx Other-Survey Reminder Phone Calls to
A.9 Survey - WIC Child Retention 20200127.docx Other-Survey - WIC Child Retention (
A.14 Survey - WIC Child Retention (Screenshots) 20200127.docx Other-Survey - WIC Child Retention (
A.12 Post-Survey Response Clarification Phone Call.docx Other-Post-Survey Response Clarifica
A.13 Post-Survey Response Clarification Email.docx Other-Post-Survey Response Clarifica
A.1 QRS WIC Child Retention Burden Table FINAL 11.13.19.xlsx QRS WIC Child Retention Burden Table IC Document
A.6 Reminder Emails to WIC Local Agency 20200127.docx Reminder Emails to WIC Local Agency IC Document
A.8 Initial Survey Notification Email to Clinic-Level Staff Member 20200127.docx Initial Survey Notification Email to Clinic-Level Staff Member IC Document
A.10 Survey Reminder Emails to Clinic-Level Staff Member 20200127.docx Survey Reminder Emails to Clinic-Level Staff member IC Document
QRS WIC Retention_OMB Clearance Memo_20200103_Clean.docx QRS WIC Child Retention Memo IC Document

Information Collection (IC) Details

IC Title:	WIC Child Retention (Private Sector) (2 of 2)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 246

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Pretest - Clinic Staff	A.3 Pretest-Clinic Staff .docx	Yes	No	Printable Only
Other-Email Request to WIC Local Agency	A.5 Email Request to WIC Local Agency 20200127.docx	Yes	Yes	Printable Only
Other-Reminder phone calls to WIC Local Agency	A.7 Reminder Phone Calls to WIC Local Agency 20200127.docx	No		Paper Only
Other-Pretest - Local Agency	A.2 Pretest-Local Agency.docx	Yes	No	Fillable Fileable
Other-Survey Reminder Phone Calls to Clinic-Level Staff Member	A.11 Survey Reminder Phone Calls to Clinic-Level Staff Member 20200127.docx	No		Paper Only
Other-Survey - WIC Child Retention (web-based)	A.9 Survey - WIC Child Retention 20200127.docx	Yes	Yes	Fillable Fileable
Other-Survey - WIC Child Retention (screen shots)	A.14 Survey - WIC Child Retention (Screenshots) 20200127.docx	Yes	Yes	Fillable Fileable
Other-Post-Survey Response Clarification Phone Call	A.12 Post-Survey Response Clarification Phone Call.docx	No		Paper Only
Other-Post-Survey Response Clarification E-mail	A.13 Post-Survey Response Clarification Email.docx	Yes	No	Printable Only

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: 420	Number of Respondents for Small Entity: 420

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,503	2,503
Annual IC Time Burden (Hours)	334	334
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
QRS WIC Child Retention Burden Table	A.1 QRS WIC Child Retention Burden Table FINAL 11.13.19.xlsx	11/13/2019
Reminder Emails to WIC Local Agency	A.6 Reminder Emails to WIC Local Agency 20200127.docx	02/07/2020
Initial Survey Notification Email to Clinic-Level Staff Member	A.8 Initial Survey Notification Email to Clinic-Level Staff Member 20200127.docx	02/07/2020
Survey Reminder Emails to Clinic-Level Staff member	A.10 Survey Reminder Emails to Clinic-Level Staff Member 20200127.docx	02/07/2020
QRS WIC Child Retention Memo	QRS WIC Retention_OMB Clearance Memo_20200103_Clean.docx	01/03/2020

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