State and Local WIC Agency Directors (SLT)

Third National Survey of WIC Participants (NSWP-III)

App B2.a Local Agency Survey

State and Local WIC Agency Directors (SLT)

OMB: 0584-0641

Document [docx]
Download: docx | pdf

OMB Number: 0584-XXXX

Expiration Date: X/XX/XXXX



APPENDIX B2.a



LOCAL AGENCY SURVEY




INTRO: Thank you for participating in the Third National Survey of WIC Participants. This survey is sponsored by the United States Department of Agriculture Food Nutrition Service and administered by 2M Research Services. Please refer to the accompanying cover letter for full details of the research effort. If you have any questions, please contact Jim Murdoch at 1-817-856-0863, or by email at [email protected].


This survey—along with surveys of State agencies and participants—is designed to provide FNS with additional information on policies and program operations, beyond those available from existing program sources.

































According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 60 minutes (1 hour) per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-xxxx*). Do not return the completed form to this address.



Certification Policies


Identity


Q1. What types of documentation does your local agency accept as proofs of identity for a WIC applicant either electronically and/or physically? (CHECK ALL THAT APPLY)

Letter from government agency (including WIC) w/name form/letter

Driver’s license, State ID

Work, school, or bus pass ID w/photo & name

Military ID

Social Security card

Voter’s registration card

Foster placement letter

Passport or immigration records

Marriage license

Birth certificate

Crib card, hospital discharge papers, or hospital ID bracelet

Immunization record

Employment paystubs

Medicaid card

Other: PLEASE SPECIFY

Other: PLEASE SPECIFY

Other: PLEASE SPECIFY

Other: PLEASE SPECIFY


Residency


Q2. What types of documentation does your local agency accept to verify the residency of a WIC applicant either electronically and/or physically? (CHECK ALL THAT APPLY)

Driver’s license

Current utility/tax bill, rent receipt, mortgage receipt, or lease receipt with name and address on it

Letter from government agency (including WIC) w/name and address

State or Tribal-issued license or ID w/name and address

Postmarked mail from reliable third party with name and address

Checkbook, bank statement

Signed statement by applicant that he/she is victim of loss or disaster, or is homeless, a migrant person, or military personnel.

Shelter documentation

Vehicle registration

Recent paystub

Property tax bill

Hospital/clinic receipt or record

Income tax return/W2 form

Social Security statement

Medicaid document

TANF document

Other: PLEASE SPECIFY

Other: PLEASE SPECIFY

Other: PLEASE SPECIFY

Other: PLEASE SPECIFY

Other: PLEASE SPECIFY: __________________________




Income


Q3. Which of the following documents satisfy the income documentation requirements of your local agency? Among those documents, rank the top three most-often provided documents (where “1” is most often provided, “2” is the second most often provided and “3” is the third most often provided):


Document

Satisfies Document Requirement

(CHECK ALL THAT APPLY)

Three Most Frequently Provided Documents

(RANK 1, 2, or 3)

a.

1st Paystub/earnings statement


b.

W-2 form


c.

IRS tax return


d.

Business records


e.

Unemployment compensation (letter, check stub, copy of check)


f.

Workers compensation (award statement, check stub, copy of check, statement from insurance company)


g.

Social Security benefits (award letter, statement of benefits, check stub, copy of check)


h.

State SSI or State disability insurance (notice of benefits, check stub, copy of check)


i.

Public assistance or TANF (notice of benefits, check stub, copy of check)


j.

Energy assistance (notice of benefits, check stub, copy of check)


k.

Alimony or child support (copy of check, agreement, divorce/separation decrees, court order)


l.

Any government or private pension, annuity, or survivor’s benefits (notice of benefits, check stub or copy of check)


m.

Estate or trust earnings statement


n.

Interest or dividends statement


o.

Savings account earnings statement


p.

Veteran’s payments (notice of benefits, check stub, copy of check)


q.

Military pay (leave and earnings statement, check stub, copy of check)


r.

Letter from employer


s.

Foster care placement letter


t.

Scholarship/financial aid letter


u.

SNAP letter showing current eligibility


v.

Other documents____________________________


w.

Other documents____________________________


x.

Other documents____________________________


y.

Other documents____________________________




Q4. Which of the following satisfy the program participation documentation requirements for automatic or adjunctive eligibility of your local agency? Among those documents, rank the top three most-often method used (where “1” is most often, “2” is the second most often, and “3” is the third most often).


Document

Satisfies Documentation Requirement

(CHECK ALL THAT APPLY)

Three Most Frequently Method Used

(RANK 1, 2, or 3)

a.

Valid program or member ID card


b.

Award letter or notice of benefits


c.

Electronic access


d.

Other: PLEASE SPECIFY:________________________




Breastfeeding


Q5. In your estimation, at what ages are infants being certified to receive “fully” (rather than “partially”) breastfeeding food packages? An estimate or best guess is okay if the information is not readily available.


Infant Age at Certification

Percentage of Infant Certifications in the past 12 months

1-3 months


4-6 months


7-9 months


10-12 months


Total

100% (all infants who were certified to receive fully breastfeeding food packages)



Denied Applicants


Q6. Does your local agency keep information on denied applicants?

  • Yes

  • No: PLEASE EXPLAIN: _____________________ [GO TO Q8]

Q7. What information on denied applicants do you retain and how is it retained? (ANSWER B. AND C. ONLY IF A. IS CHECKED.)

a. Information Retained

(CHECK ALL THAT APPLY)

b. How Retained (CHECK ONE)

c. Where Retained (Readily accessible to the….)

(CHECK ALL THAT APPLY)

Name of applicant

Paper copy only

WIC State Agency



Electronic copy only

Your Local Agency



Both paper and electronic

Sites/Clinics

Address

Paper copy only

WIC State Agency



Electronic copy only

Your Local Agency



Both paper and electronic

Sites/Clinics

Phone number

Paper copy only

WIC State Agency



Electronic copy only

Your Local Agency



Both paper and electronic

Sites/Clinics

WIC applicant category

Paper copy only

WIC State Agency



Electronic copy only

Your Local Agency



Both paper and electronic

Sites/Clinics

Reason for denial

Paper copy only

WIC State Agency



Electronic copy only

Your Local Agency



Both paper and electronic

Sites/Clinics

Date of application

Paper copy only

WIC State Agency



Electronic copy only

Your Local Agency



Both paper and electronic

Sites/Clinics

Date of denial

Paper copy only

WIC State Agency



Electronic copy only

Your Local Agency



Both paper and electronic

Sites/Clinics


Q8. Of applicants new to your WIC agency, what percentage in the past 12 months was denied certification? (SELECT ONE)

  • 1%

  • 2 – 4%

  • 5 – 7%

  • 8 – 10%

  • >10%


Q8A. How confident are you in the range entered here?

Very confident

Somewhat confident

Not very confident (i.e., a lot of guesswork involved)


Q9. Of current WIC participants seeking certification (or recertification) at your WIC agency, what percentage in the past 12 months was denied certification? (SELECT ONE)

  • 1%

  • 2 – 4%

  • 5 – 7%

  • 8 – 10%

  • >10%


Q9A. How confident are you in the range entered here?

Very confident

Somewhat confident

Not very confident (i.e., a lot of guesswork involved)


Q10. Please specify the percentage of denials reported above that are attributable to the following eligibility problems. It is possible the percentages may sum to more than 100%, as applicants may be denied for more than one reason.


Reason for Denial

Percentage Distribution for New Applicants

Percentage Distribution for Certification

a.

Lack of documentation provided for identity


b.

Income ineligibility (over income limit)


c.

Lack of documentation provided for residency


d.

Categorical ineligibility (i.e., not pregnant, child over 5 years, etc.)



e.

Other: PLEASE SPECIFY____________________________




Q10A. How confident are you in the responses that were entered here?

Very confident

Somewhat confident

Not very confident (i.e., a lot of guesswork involved)


Q11. Does your agency provide an official letter of denial to applicants who are determined ineligible for WIC?

  • Yes

  • No

  • Other: PLEASE SPECIFY: ____________________________


Q12. Can an applicant be screened and determined ineligible by telephone?

  • Yes

  • No [GO TO Q14]


Q13. IF Q11=YES AND Q12=YES

What is the percentage of denials through screening phone calls versus formal, in-person applications in the past 12 months?



Percentage of Denials

Screening phone calls


Formal in-person applications







Location of Certification


Q14. Does your agency offer or provide certification at alternative sites (e.g., satellite, mobile, or off-site clinics at a hospital, school, etc.)?

  • Yes

  • Yes, only during disaster/emergency situations

  • No [GO TO Q16]


Q14A. Which of the following WIC categories does your agency offer certification at alternative sites? (CHECK ALL THAT APPLY)

Pregnant woman

Postpartum woman

Breastfeeding woman

Infant

Child

  • None


Q15. Under what circumstances is certification provided at an alternative site such as a satellite clinic, mobile clinic, or off-site clinics at hospitals, schools and other locations? What is your agency’s policy toward providing certifications at an alternative site?


___________________________________________________________________________


___________________________________________________________________________


___________________________________________________________________________



Certification Staffing


Q16. Does your staff receive cross-training on ALL of the certification-related tasks shown below?

  • Assess categorical eligibility criteria

  • Assess residential eligibility criteria

  • Assess nutritional risk criteria

  • Assess income/adjunctive income eligibility

  • Issue benefits (vouchers/EBT cards)


  • Yes, we have certification staff who are cross-trained on ALL of those tasks.

  • No, our certification staff specializes in one or more of those tasks. [GO TO Q17]


Q16A. What percentage of your certification staff is cross-trained on ALL of those tasks?

__ __ __%


Q17. Among all full-time staff in your jurisdiction who conduct certification, what is their average monthly caseload?

______ participants


Operations


Administration


Q18. Is your local agency… (CHECK ONE)

  • part of the State agency

  • a local government entity administering the WIC program

  • a tribal entity/organization administering the WIC program

  • a non-profit organization that has been contracted to run the WIC program

  • not a local agency, but rather a clinic under a local agency

  • Other: PLEASE SPECIFY ___________________________


Physical Space


Q19. Which description most closely fits the structure in which your local agency is located? (CHECK ONE)

  • Health department or medical clinic

  • Social services office or agency

  • Full service hospital

  • School

  • Head Start

  • Community center

  • Mobile clinic (van)

  • Migrant health center and/or camp

  • Indian Health Service facility

  • Religious center

  • Standalone WIC clinic

  • Nonprofit

  • Other: PLEASE SPECIFY ___________________________


Q20. Of the spaces available at WIC clinics in your jurisdiction, how adequate would you rate the following spaces for optimally delivering WIC services to your participants at this time? Please rate each type of room. [rooms marked “somewhat adequate” or “not at all adequate,” go to q20a]


Type of Room

Completely
Adequate

Mostly

Adequate

Somewhat Adequate

Not at All Adequate

N/A

Large waiting rooms/reception areas (greater than 15x15 feet)

Small waiting rooms/reception areas (15x15 feet or smaller)

Rooms, offices, or cubicles where clients are seen

Separate breastfeeding rooms

Large training/conference/multipurpose rooms

Small training/conference/multipurpose rooms

Administrative offices (no clients seen)

Administrative cubicles (no clients seen)

Laboratory (height/weight taking areas)

Other: PLEASE SPECIFY ___________________________



Q20A. Please explain why you selected [response from q20: “SOMEWHAT ADEQUATE” OR “NOT AT ALL ADEQUATE”] for the following rooms [type of room associated with “somewhat adequate” or “not at all adequate” response]:
_____________________________________________________________________


Q21. How would you rate the physical security of your local agency’s location (for example, protection from natural disasters such as fire, earthquake; burglary or vandalism of the site; unauthorized visitors; etc.)?

  • Very safe (no incidents) [go to Q22]

  • Safe (occasional minor incidents) [go to q22]

  • Unsafe (occasional major incidents or frequent minor incidents)

  • Very unsafe (frequent major incidents)


Q21A. Please explain why you selected [response from q21: “unsafe” or “very unsAfe”]:
_____________________________________________________________________

Services Information


Q22. Please enter the number of WIC sites that operate under the authority of this local agency, by type.

Clinics (defined as a permanent location assigned to the WIC program; include main clinic)

Satellites (defined as a location such as a school, church or town hall that is only temporarily assigned the WIC program. WIC staff must carry their own files and equipment to the site each visit)

Mobile Units (a vehicle assigned to the WIC program that may make multiple stops to conduct certifications)


Q23. To what extent are the following services provided by your local agency at the various sites you specified in the previous question? [WEB SURVEY WILL SHOW CLINICS, SATELLITES AND/OR MOBILE UNITS COLUMN ONLY IF RESPONDENT HAS ANSWERED >0 IN Q22]





Local Agency


Clinics


Satellites


Mobile Units


Agency does this

All can
do

Some can do

None can do

All can
do

Some can do

None can do

All can
do

Some can do

None can do

Conduct certifications

Perform blood testing

Take anthropometric measurements for height, weight, and body mass index (BMI)

Conduct nutrition counseling

Offer other educational seminars (e.g., on breastfeeding)

Provide food instruments (vouchers/EBT cards)

Provide referrals to other services

Access WIC participant records electronically



Q24. Across all of the clinics under your local agency, on average, how many days per week, is the clinic open to clients/applicants? DAYS


Q25. Across all of the clinics under your local agency, on average, how many hours per week, is the clinic open to clients/applicants? (You may divide the total number of hours that all clinics are open by the number of clinics.) HOURS


Q26. Across all of the clinics under your local agency, provide the opening and closing hours (hours open to the public) for a typical clinic (your most common clinic) in a typical week of operations in the table below.


Operating Hours

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Opening







Closing








Q26A. Do your clinics typically close to the public for lunch or other reasons during clinic hours?

  • Yes

  • No


Staffing


Q27.


Across all of the clinics under your local agency, please provide the following information for each position listed below. [PLEASE GIVE NUMBER]

Number of full-time staff

(working more than 32 hours/wk)

Number of part-time staff (working less than 32 hours/wk)

Of the total combined full and part-time staff, how many have worked at one of your clinics 12 months or less?

Of all of the employees who have held this position in the past 12 months, how many have left your agency (are not working at any of your clinics)?

Across all of the clinics under your local agency, how many of these positions are currently vacant?

a. WIC Director or Clinic Supervisor



______

______

______

b. Office Manager



______

______

______

c. Administrative Support Staff (e.g., clerks)



______

______

______

d. Certification Specialist



______

______

______

e. Registered Dietitian



______

______

______

f. Degreed/Licensed Nutritionist



______

______

______

g. Trained Nutrition Paraprofessional



______

______

______

h. Registered Nurse/Physician Assistant



______

______

______

i. Physician



______

______

______

j. Social Worker/ Psychologist/ Therapist



______

______

______

k. Other Professional (e.g., breastfeeding peer counselors, IBCLC)



______

______

______

l. Other: PLEASE SPECIFY___________



______

______

______

TOTAL STAFF



______

______

______

[Programming note: Total Staff row will be calculated automatically so respondent can see totals]


Q27A. From your answers above, we estimate that your full-time equivalent (FTE) number of employees is approximately ____. (Note:, we counted every two part-time as one FTE.) Do you agree with this estimate?

  • Yes, GO TO Q28

  • No



Q27B. What is your estimate of FTE number of employees across all clinics in your jurisdiction? _____ FTE



Q28. Across all clinics under your local agency, what percentage of all staff are bilingual or multilingual?
_____% of staff

Q29. What languages, other than English, are spoken by staff at one or more of the clinics under your local agency to assist in providing WIC services? (CHECK ALL THAT APPLY)


NONE

Hmong

Spanish

Arabic

Khmer

Swahili

Cambodian

Korean

Tamil

Cantonese/Mandarin

Laotian

Tagalog

Farsi

Portuguese

Urdu

French/Creole

Punjabi

Vietnamese

Fulani

Russian

Other: SPECIFY

Hindi

Somali



Q30. What difficulties does your local agency face in retaining, recruiting, and hiring staff? (CHECK ALL THAT APPLY)

  • Salaries not competitive

  • Salaries not commensurate with level of job duties

  • Benefits not competitive

  • Minimal training and job growth offered

  • Workload too great

  • Location of local agency unsafe

  • Location of local agency hard to get to

  • Physical space occupied by local agency crowded

  • Low employee morale throughout agency

  • Lack of support for WIC program from State

  • Limited career path or opportunities for promotion

  • Required skillset lacking in prospective employees

  • Other: PLEASE SPECIFY __________________

  • None of the above



Caseload


Q31. Currently, approximately how many clients are served by all of the clinics under your local agency combined per month?

CLIENTS/MONTH





Technology


Q32. Does the typical clinic under your local agency have on-site the necessary technology, equipment, supplies, etc., to do the following tasks?


Yes

No

Don’t Know

  1. Enter/access client certification information via a computer?

b. Perform hematological tests?

c. Take anthropometric measurements for weight and height, and to calculate BMI (body mass)?




Retention

The next set of questions concern the retention of WIC participants by participant category. We understand that local agencies may use different ways to define retention within the participant categories. Therefore, we will first ask you to explain how you determine retention and then ask for some data on retention over the last five Federal fiscal years (FYs).

Q33. Does your local agency determine retention for WIC participants?

  • Yes

  • No, determined by State agency [GO TO Q34]

  • No, not determined at all [GO TO Q34]

  • Not sure [GO TO Q34]


Q33A. How does your Local Agency define retention of WIC participants? Please describe any differences in definitions for infants, children, pregnant women, postpartum women, and breastfeeding women.


_____________________________________________________________________________


_____________________________________________________________________________


_____________________________________________________________________________



Q33B. How often do you calculate retention? (CHECK ALL THAT APPLY)

Weekly

Monthly

Quarterly

Annually

Other: PLEASE SPECIFY _________________________________


Q33C. Now we would like get information to enable us to determine your retention rates. Please complete the following table, which includes information for the past 5 Federal fiscal years (FY). Please enter a number for Total Certified, and either a number or percent for Total Retained [Note: if you have a standardized report(s) with this information you may upload that information here: {link}]




FY 2013

FY 2014

FY 2015

FY 2016

FY 2017

Category

Total Certified

Total Retained

Total Certified

Total Retained

Total Certified

Total Retained

Total Certified

Total Retained

Total Certified

Total Retained

Infants




Number

Percent




Number

Percent




Number

Percent




Number

Percent




Number

Percent

Children




Number

Percent




Number

Percent




Number

Percent




Number

Percent




Number

Percent

Pregnant Women




Number

Percent




Number

Percent




Number

Percent




Number

Percent




Number

Percent

Postpartum Women




Number

Percent




Number

Percent




Number

Percent




Number

Percent




Number

Percent

Breastfeeding Women




Number

Percent




Number

Percent




Number

Percent




Number

Percent




Number

Percent



Q34. Does your local agency attempt to contact pregnant women who miss their first appointment (to apply for participation in the program) in order to reschedule the appointment?

  • Yes

  • No


Q35. Does your local agency, or any of the clinics under your local agency, do any of the following to increase WIC participant retention rates? (CHECK ALL THAT APPLY)

  • Advertise via traditional delivery channels (including on television, movie theaters, internet, print publication materials, radio, gas stations, etc.)

  • Post social media advertisements (Facebook, Pinterest, Twitter, Instagram, etc.)

  • Send first birthday card to WIC caregivers on child’s first birthday

  • Text message appointment reminders

  • Provide transportation to and from sites

  • Provide childcare onsite

  • Encourage current participants to invite eligible family and friends to enroll and remain active

  • Encourage healthcare professionals (doctors, nurses, midwives, etc.) to inform eligible women to enroll and remain active

  • Other: PLEASE SPECIFY______________________________________________________


[SUBMIT]


End Survey


Thank you for participating in this survey!


pg. 18

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleREVISED
SubjectAG-3198-S-15-0040
AuthorJoshua Townley
File Modified0000-00-00
File Created2021-01-21

© 2024 OMB.report | Privacy Policy