State and Local WIC Agency Directors (SLT)

APPENDIX B7.a

DENIED APPLICANT LOG REQUEST EMAIL

XX/XX/XXXX

To: [la email address]
Subject: Denied Applicants and the “Third National Survey of WIC Participants” Study (NSWP-III)

Dear [NAME]:

2M Research Services and its partner, Abt Associates, are working with Capital Consulting Corporation, a company that does research studies in health and human services, to conduct a study for the U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) called “Third National Survey of WIC Participants (NSWP-III).”

We have already contacted you about participating in the Local Agency Survey; however, we are requesting your help to collect some information. For one part of the study, we need to interview individuals who apply for WIC through your agency and who you determine do not meet certification requirements. Working with your State agency, we requested records of these “denied applicants” from your agency, but we would like to identify any additional denied applicants over the course of the next XXX weeks/months.

We are requesting that your agency keep a log of individuals who apply for WIC between [date] and [date] but who are found to be ineligible for any reason (for example, applicants who do not meet any participant category criteria; who not meet income eligibility guidelines; or applicants who fail to provide necessary documentation of income, identity, or residency). We understand that you may deny very few or even no applicants during this period. For instance, your agency may screen out individuals who call the agency to ask about getting WIC but whom your staff determine would be unlikely to qualify. Nevertheless, if your agency determines that any formal applicant is ineligible during this period, FNS would like us to invite these individuals to participate in the study.

[Statement regarding authorization to collect private information—state specific. Example: As agreed upon with [STATE AGENCY], the research team, 2M Research Services, Abt Associates, and Capitol Consulting Corporation, are authorized, on behalf of FNS, to collected information on denied WIC applicants in order to fulfill the requirements of the Improper Payments Elimination and Recovery Improvement Act (IPERIA) of 2012 (P.L. 112-248).]

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 1 minute 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.

The log is attached to this email. The first tab includes the types of information that we would like you to collect from denied applicants. The second tab includes definitions of each of the types of information. Please note that this log should only include persons who formally apply for WIC. The log should not include information from pre-screened individuals who inquire about their likelihood of qualifying for WIC but who choose not to formally apply. Someone from the research team will contact you by phone within five business days to answer your questions about keeping the log.

Please do NOT send any information about individual applicants via email. Email is not a secure method of sending personally identifiable information. Instead, we will contact you approximately once per month and ask you to submit data from the log via a secure website, [URL]. To access the site, please enter your PIN number, which is [NUMBER]. We also have technical staff who can assist you with this process.

We thank you in advance for your important contribution to this research. If you have any questions, please contact us by calling us at [PHONE NUMBER] or email at [email].

Sincerely,

[Research team contact information]

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