Information Collection

Current, Former, and Recently Denied WIC Participants (Individuals/Households)

IC 229849 under ICR 201801-0584-002 · OMB 0584-0641.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App B3.a Certification Survey Version A (Adult) - English.docx	Other-Appendix B3.a Certification Su
App B3.b Certification Survey Version B (Infant_Child) - English.docx	Other-Appendix B3.b Ceritfication Su
App B3.c Certification Survey Version A (Adult) - Spanish.docx	Other-Appendix B3.c Certification Su
App B3.d Certification Survey Version B (Infant_Child) - Spanish.docx	Other-Appendix B3.d Certification Su
App B4.a Denied Applicant Survey Version A (Adult) - English.docx	Other-Appendix B4.a Denied Applicant
App B4.b Denied Applicant Survey Version B (Infant_Child)- English.docx	Other-Appendix B4.b Denied Applicant
App B4.c Denied Applicant Survey Version A (Adult) - Spanish.docx	Other-Appendix B4.c Denied Applicant
App B4.d Denied Applicant Survey Version B (Infant_Child) - Spanish.docx	Other-Appendix B4.d Denied Applicant
App B5.a Program Experiences Survey Version A (Adult) - English.docx	Other-Appendix B5.a Program Experien
App B5.b Program Experiences Survey Version B (Infant_Child) - English.docx	Other-Appendix B5.b Program Experien
App B5.c Program Experiences Survey Version A (Adult).docx	Other-Appendix B5.c Program Experien
App B5.d Program Experiences Survey Version B (Infant_Child).docx	Other-Appendix B5.d Program Experien
App B6.a Former WIC Participant Case Study Interview Guide.docx	Other-Appendix B6.a Former WIC Parti
App B6.b Former WIC Participant Case Study Interview Guide.docx	Other-Appendix B6.b Former WIC Parti
App C11.a Certification Survey Recruitment Telephone Script - English.docx	Other-Appendix C11.a Certifcation Su
App C11.b Certification Survey Recruitment Telephone Script-Spanish.docx	Other-Appendix C11.b Certification S
App C12.a Certification Survey Recruitment In-Person Script-English.docx	Other-Appendix C12.a Certification S
App C12.b Certification Survey Recruitment In-Person Script - Spanish.docx	Other-Appendix C12.b Certification S
App C14.a Telephone Reminder for Scheduled Certification Survey - English.docx	Other-Appendix C14.a Telephone Remin
App C14.b Telephone Reminder for Scheduled Certification Survey - Spanish.docx	Other-Appendix C14.b Telephone Remin
App C15.a Denied WIC Applicant Survey Recruitment Telephone Script - English.docx	Other-Appendix C15.a Denied WIC Appl
App C15.b Denied WIC Applicant Survey Recruitment Telephone Script - Spanish.docx	Other-Appendix C15.b Denied WIC Appl
App C16.a Denied WIC Applicant Survey Recruitment In-Person Script - English.docx	Other-Appendix C16.a Denied WIC Appl
App C16.b Denied WIC Applicant Survey Recruitment In-Person Script - Spanish.docx	Other-Appendix C16.b Denied WIC Appl
App C18.a Telephone Reminder for Scheduled Denied Applicant Survey - English.docx	Other-Appendix C18.a Telephone Remin
App C18.b Telephone Reminder for Scheduled Denied Applicant Survey- Spanish.docx	Other-Appendix C18.b Telephone Remin
App C19.a Program Experiences Survey Invitation Telephone Script-English.docx	Other-Appendix C19.a Program Experie
App C19.b Program Experiences Survey Invitation Telephone Script - Spanish.docx	Other-Appendix C19.b Program Experie
App C22.a Program Experiences Survey Invitation In-Person Script - English.docx	Other-Appendix C22.a Program Experie
App C22.b. Program Experiences Survey Invitation In-Person Script - Spanish.docx	Other-Appendix C22.b Program Experie
App C23.a FormerWICParticipantCaseStudyInterviewInvitationTelephoneScript_English.docx	Other-Appendix C23.a Former WIC Part
App C23.b FormerWICPartCaseStudyIntervInviteTelScript - Spanish.docx	Other-Appendix C23.b Former WIC Part
App D7.a Participant Consent Form Certification Survey - English.docx	Other-Appendix D7.a Participant Cons
App D7.b Participant Consent Form Certification Survey - Spanish.docx	Other-Appendix D7.b Participant Cons
App D9.a Participant Consent Form Denied Applicant Survey.docx	Other-Appendix D9.a Participant Cons
App D9.b Participant Consent Form Denied Applicant Survey - Spanish.docx	Other-Appendix D9.b Participant Cons
App C13.a Text Message Reminder for Scheduled Certification Survey - English.docx Appendix C13.a Text Message Reminder for Scheduled Certification Survey - English	IC Document
App C13.b Text Message Reminder for Scheduled Certification Survey - Spanish.docx Appendix C13.b Text Message Reminder for Scheduled Certification Survey - Spanish	IC Document
App C17.a Text Message Reminder for Scheduled Denied Applicant Survey - English.docx Appendix C17.a Text Message Reminder for Scheduled Denied Applicant Survey - English	IC Document
App C17.b Text Message Reminder for Scheduled Denied Applicant Survey- Spanish.docx Appendix C17.b Text Message Reminder for Scheduled Denied Applicant Survey - Spanish	IC Document
App C20.a. Program Experiences Survey Invitation Letter - English.docx Appendix C20.a Program Experiences Survey Invitation Letter - English	IC Document
App C20.b. Program Experiences Survey Invitation Letter - Spanish.docx Appendix C20.b Program Experiences Survey Invitation Letter - Spanish	IC Document
App C21.a. Program Experiences Survey Invitation Email - English.docx Appendix C21.a Program Experiences Survey Invitation Email - English	IC Document
App C21.b. Program Experiences Survey Invitation Email - Spanish.docx Appendix C21.b Program Experiences Survey Invitation Email - Spanish	IC Document
App D6.a Certification Survey Information Letter from State Agencies - English.docx Appendix D6.a Certification Survey Information Letter from State Agencies - English	IC Document
App D6.b Certification Survey Information Letter from State Agencies- Spanish.docx Appendix D6.b Certification Survey Information Letter from State Agencies - Spanish	IC Document
App D8.a Denied WIC Applicant Information Letter from State Agencies - English.docx Appendix D8.a Denied WIC Applicant Information Letter from State Agencies - English	IC Document
App D8.b. Denied WIC Applicant Information Letter from State Agencies - Spanish.docx Appendix D8.b Denied WIC Applicant Information Letter from State Agencies - Spanish	IC Document
App D10.a. Program Experiences Survey Invitation Postcard.docx Appendix D10.a Program Experiences Survey Invitation Postcard - English	IC Document
App D10.b. Program Experiences Survey Invitation Postcard - Spanish.docx Appendix D10.b Program Experiences Survey Invitation Postcard - Spanish	IC Document
App D11.a Participant Information Brochures.docx Appendix D11.a Participant Information Brochure - English	IC Document
App D11.b Participant Information Brochure - Spanish.docx Appendix D11.b Participant Information Brochure - Spanish	IC Document
App D12.a PES Thank You Letter and Gift Card - English.docx Appendix D12.a Program Experiences Servey Thank You Letter and Visa Debit Card - English	IC Document
App D12.b PES Thank You Letter and Gift Card - Spanish.docx Appendix D12.b Program Experiences Survey Thank You Letter and Visa Debit Card - Spanish	IC Document
App D13.a FormerWICParticipantCaseStudyInterviewThankYouLetterandGiftCard - English.docx Appendix D13.a Former WIC Participant Case Study Interview Thank You Letter and Visa Debit Card - English	IC Document
App D13.b FormerWICPartCaseStudyInterview_ThankYou_GiftCard_Spanish.docx Appendix D13.b Former WIC Participant Case Study Interview Thank You Letter and Visa Debit Card - Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Current, Former, and Recently Denied WIC Participants (Individuals/Households)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix B3.a Certification Survey Version A (Adult) - English	Yes	Yes	Fillable Fileable
Other-Appendix B3.b Ceritfication Survey Version B (Infant/Child) - English	Yes	Yes	Fillable Fileable
Other-Appendix B3.c Certification Survey Version A (Adult) - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix B3.d Certification Survey Version B (Infant/Child) - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix B4.a Denied Applicant Survey Version A (Adult) - English	Yes	Yes	Fillable Fileable
Other-Appendix B4.b Denied Applicant Survey Version B (Infant/Child) - English	Yes	Yes	Fillable Fileable
Other-Appendix B4.c Denied Applicant Survey: Version A (Adult) - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix B4.d Denied Applicant Survey Version B (Infant/Child) - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix B5.a Program Experiences Survey Version A (Adult) - English	Yes	Yes	Fillable Fileable
Other-Appendix B5.b Program Experiences Survey Version B (Infant/Child) - English	Yes	Yes	Fillable Fileable
Other-Appendix B5.c Program Experiences Survey Version A (Adult) - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix B5.d Program Experiences Survey Version B (Infant/Child) - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix B6.a Former WIC Participant Case Study Interview Guide - English	No		Paper Only
Other-Appendix B6.b Former WIC Participant Case Study Interview Guide - Spanish	No		Paper Only
Other-Appendix C11.a Certifcation Survey Recruitment Telephone Script - English	Yes	Yes	Fillable Fileable
Other-Appendix C11.b Certification Survey Recruitment Telephone Script - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix C12.a Certification Survey recruitment In-Person Script - English	No		Paper Only
Other-Appendix C12.b Certification Survey Recruitment In-Person Script - Spanish	No		Paper Only
Other-Appendix C14.a Telephone Reminder for Scheduled Certification Survey - English	Yes	Yes	Fillable Fileable
Other-Appendix C14.b Telephone Reminder for Scheduled Certification Survey - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix C15.a Denied WIC Applicant Survey Recruitment Telephone Script - English	Yes	Yes	Fillable Fileable
Other-Appendix C15.b Denied WIC Applicant Survey Recruitment Telephone Script - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix C16.a Denied WIC Applicant Survey Recruitment In-Person Script - English	No		Paper Only
Other-Appendix C16.b Denied WIC Applicant Survey Recruitment In-Person Script - Spanish	No		Paper Only
Other-Appendix C18.a Telephone Reminder for Scheduled Denied Applicant Survey - English	Yes	Yes	Fillable Fileable
Other-Appendix C18.b Telephone Reminder for Scheduled Denied Applicant Survey - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix C19.a Program Experiences Survey Invitation Telephone Script - English	Yes	Yes	Fillable Fileable
Other-Appendix C19.b Program Experiences Survey Invitation Telephone Script - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix C22.a Program Experiences Survey Invitaton In-Person Script - English	No		Paper Only
Other-Appendix C22.b Program Experiences Survey Invitation In-Person Script - Spanish	No		Paper Only
Other-Appendix C23.a Former WIC Participant Case Study Interview Invitation Telephone Script - English	Yes	Yes	Fillable Fileable
Other-Appendix C23.b Former WIC Participant Case Study Interview Invitation Telephone Script - Spanish	Yes	Yes	Fillable Fileable
Other-Appendix D7.a Participant Consent Form - Certification Survey - English	No		Paper Only
Other-Appendix D7.b Participant Consent Form - Certification Survey-Spanish	No		Paper Only
Other-Appendix D9.a Participant Consent Form - Denied Applicant Survey - English	No		Paper Only
Other-Appendix D9.b Participant Consent Form - Denied Applicant Survey - Spanish	No		Paper Only

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: 3,475

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 57 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16,727	16,727
Annual IC Time Burden (Hours)	3,474	3,474
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix C13.a Text Message Reminder for Scheduled Certification Survey - English		01/30/2018
Appendix C13.b Text Message Reminder for Scheduled Certification Survey - Spanish		01/30/2018
Appendix C17.a Text Message Reminder for Scheduled Denied Applicant Survey - English		01/30/2018
Appendix C17.b Text Message Reminder for Scheduled Denied Applicant Survey - Spanish		01/30/2018
Appendix C20.a Program Experiences Survey Invitation Letter - English		01/30/2018
Appendix C20.b Program Experiences Survey Invitation Letter - Spanish		01/30/2018
Appendix C21.a Program Experiences Survey Invitation Email - English		01/30/2018
Appendix C21.b Program Experiences Survey Invitation Email - Spanish		01/30/2018
Appendix D6.a Certification Survey Information Letter from State Agencies - English		01/30/2018
Appendix D6.b Certification Survey Information Letter from State Agencies - Spanish		01/30/2018
Appendix D8.a Denied WIC Applicant Information Letter from State Agencies - English		01/30/2018
Appendix D8.b Denied WIC Applicant Information Letter from State Agencies - Spanish		01/30/2018
Appendix D10.a Program Experiences Survey Invitation Postcard - English		01/31/2018
Appendix D10.b Program Experiences Survey Invitation Postcard - Spanish		01/31/2018
Appendix D11.a Participant Information Brochure - English		01/31/2018
Appendix D11.b Participant Information Brochure - Spanish		01/31/2018
Appendix D12.a Program Experiences Servey Thank You Letter and Visa Debit Card - English		01/31/2018
Appendix D12.b Program Experiences Survey Thank You Letter and Visa Debit Card - Spanish		01/31/2018
Appendix D13.a Former WIC Participant Case Study Interview Thank You Letter and Visa Debit Card - English		01/31/2018
Appendix D13.b Former WIC Participant Case Study Interview Thank You Letter and Visa Debit Card - Spanish		01/31/2018

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

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