Information Collection

State and Local WIC Agency Directors (SLT)

IC 229847 under ICR 201801-0584-002 · OMB 0584-0641.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App B1.b State Agency Survey (Screenshots)_revised.docx	Other-Appendix B1.b State Agency Sur
App B2.a Local Agency Survey.docx	Other-Appendix B2.a Local Agency Sur
App B2.b Local Agency Survey (Screenshots).docx	Other-Appendix B2.b Local Agency Sur
App B7.a Denied Applicant Log Request Email.docx	Other-Appendix B7.a Denied Applicant
App B7.b Denied Applicant Log.xlsx	Other-Appendix B7.b Denied Applicant
App B7.d Denied Applicant Log Reminder Telephone Script.docx	Other-Appendix B7.d Denied Applicant
App B8. State Agency Administrative Data Request Email.docx	Other-Appendix B8 State Agency Admin
App C6. State Agency Survey Reminder Telephone Script.docx	Other-Appendix C6 State Agency Surve
App C10. Local Agency Survey Reminder Telephone Script.docx	Other-Appendix C10 Local Agency Surv
App C24 WIC Administrative Data Request to States from Regions.docx	Other-Appendix C24 WIC Administrativ
App C25 State Agency Administrative Data Request Reminder Email.docx	Other-Appendix C25 State Agency Admi
App C26 State Agency Administrative Data Request Reminder Telephone Script.docx	Other-Appendix C26 State Agency Admi
App D4. Certification End Date Verification Reminder Telephone Script.docx	Other-Appendix D4 Certification End
App B1.a State Agency Survey Revised 9.18.18.docx	Other-Appendix B1.a State Agency Sur
App B7.c Denied Applicant Log Request Reminder.docx Appendix B7.c Denied Applicant Log Request Reminder Email	IC Document
App C2. Letter to State Agencies from Regional Offices.docx Appendix C2 Letter to State Agencies from Regional Offices	IC Document
App C3. State Agency Survey Invitation Email.docx Appendix C3 State Agency Survey Invitation Email	IC Document
App C4. State Agency Survey Invitation Letter with Instrument.docx Appendix C4 State Agency Survey Invitation Letter with Instrument	IC Document
App C5. State Agency Survey Reminder Email.docx Appendix C5 State Agency Survey Reminder Email	IC Document
App C7. Local Agency Survey Invitation Email.docx Appendix C7 Local Agency Survey Invitation Email	IC Document
App C8. Local Agency Survey Invitation Letter with Instrument.docx Appendix C8 Local Agency Survey Invitation Letter with Instrument	IC Document
App C9. Local Agency Survey Reminder Email.docx Appendix C9 Local Agency Survey Reminder Email	IC Document
App D1. Study Description for State and Local WIC Agencies.docx Appendix D1 Study Description for State and Local WIC Agencies	IC Document
App D2. State Agency Survey Thank You Letter.docx Appendix D2 State Agency Survey Thank You Letter	IC Document
App D3. Certification End Date Verification Email.docx Appendix D3 Certification End Date Verification Email	IC Document
App D5. Local Agency Survey Thank You Letter.docx Appendix D5 Local Agency Survey Thank You Letter	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State and Local WIC Agency Directors (SLT)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 215.11 7 CFR 246.7

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix B1.b State Agency Survey - Screenshots	App B1.b State Agency Survey (Screenshots)_revised.docx	Yes	Yes	Fillable Fileable
Other-Appendix B1.a State Agency Survey	App B1.a State Agency Survey Revised 9.18.18.docx	Yes	Yes	Fillable Fileable
Other-Appendix D4 Certification End Date Verification Reminder Telephone Script	App D4. Certification End Date Verification Reminder Telephone Script.docx	Yes	Yes	Fillable Fileable
Other-Appendix C24 WIC Administrative Data Request to States from Regions	App C24 WIC Administrative Data Request to States from Regions.docx	Yes	Yes	Fillable Fileable
Other-Appendix C25 State Agency Administrative Data Request Reminder Email	App C25 State Agency Administrative Data Request Reminder Email.docx	Yes	Yes	Fillable Fileable
Other-Appendix C26 State Agency Administrative Data Request Reminder Telephone Script	App C26 State Agency Administrative Data Request Reminder Telephone Script.docx	Yes	Yes	Fillable Fileable
Other-Appendix B2.a Local Agency Survey	App B2.a Local Agency Survey.docx	Yes	Yes	Fillable Fileable
Other-Appendix B2.b Local Agency Survey - Screenshots	App B2.b Local Agency Survey (Screenshots).docx	Yes	Yes	Fillable Fileable
Other-Appendix B7.a Denied Applicant Log Request Email	App B7.a Denied Applicant Log Request Email.docx	Yes	Yes	Fillable Fileable
Other-Appendix B7.b Denied Applicant Log	App B7.b Denied Applicant Log.xlsx	Yes	Yes	Fillable Fileable
Other-Appendix B7.d Denied Applicant Log Request Reminder Telephone Script	App B7.d Denied Applicant Log Reminder Telephone Script.docx	Yes	Yes	Fillable Fileable
Other-Appendix B8 State Agency Administrative Data Request Email	App B8. State Agency Administrative Data Request Email.docx	Yes	Yes	Fillable Fileable
Other-Appendix C6 State Agency Survey Reminder Telephone Script	App C6. State Agency Survey Reminder Telephone Script.docx	Yes	Yes	Fillable Fileable
Other-Appendix C10 Local Agency Survey Reminder Telephone Script	App C10. Local Agency Survey Reminder Telephone Script.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: 900

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,814	4,814
Annual IC Time Burden (Hours)	1,121	1,121
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix B7.c Denied Applicant Log Request Reminder Email	App B7.c Denied Applicant Log Request Reminder.docx	01/29/2018
Appendix C2 Letter to State Agencies from Regional Offices	App C2. Letter to State Agencies from Regional Offices.docx	01/29/2018
Appendix C3 State Agency Survey Invitation Email	App C3. State Agency Survey Invitation Email.docx	01/29/2018
Appendix C4 State Agency Survey Invitation Letter with Instrument	App C4. State Agency Survey Invitation Letter with Instrument.docx	01/29/2018
Appendix C5 State Agency Survey Reminder Email	App C5. State Agency Survey Reminder Email.docx	01/29/2018
Appendix C7 Local Agency Survey Invitation Email	App C7. Local Agency Survey Invitation Email.docx	01/29/2018
Appendix C8 Local Agency Survey Invitation Letter with Instrument	App C8. Local Agency Survey Invitation Letter with Instrument.docx	01/29/2018
Appendix C9 Local Agency Survey Reminder Email	App C9. Local Agency Survey Reminder Email.docx	01/29/2018
Appendix D1 Study Description for State and Local WIC Agencies	App D1. Study Description for State and Local WIC Agencies.docx	01/30/2018
Appendix D2 State Agency Survey Thank You Letter	App D2. State Agency Survey Thank You Letter.docx	01/30/2018
Appendix D3 Certification End Date Verification Email	App D3. Certification End Date Verification Email.docx	01/30/2018
Appendix D5 Local Agency Survey Thank You Letter	App D5. Local Agency Survey Thank You Letter.docx	01/30/2018

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