Information Collection

State WIC Agency Officials (2020 and 2022)

IC 219981 under ICR 202006-0584-002 · OMB 0584-0609.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0609 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
H. Data Transmittal Worksheet Revised 11.27.19.docx	Other-Attachment H. Data Transmittal
I. Nutritional Risk Crosswalk.docx	Other-Appendix I. Nutritional Risk W
J. Contact Request Form.docx	Other-Appendix J. Contact Request Fo
M. Telephone Script for Follow-up Calls After Data Submission.docx	Other-Appendix M. Telephone Script f
C. Notification Letter for Guidance to WIC State Agencies.docx Appendix C. Notification Letter for Guidance to WIC State Agencies	IC Document
D. Guidance for WIC State Agencies Providing Participant Data Revised 11.27.19.docx Appendix D. Guidance for WIC State Agencies Providing Participant Data	IC Document
K. Sample Reminder Email to WIC State Agencies.docx Appendix K. Sample Reminder Email to WIC State Agencies	IC Document
L. Sample Follow-Up Email to State Agencies.docx Appendix L. Sample Follow-Up Emal to State Agencies	IC Document

IC Title:

State WIC Agency Officials (2020 and 2022)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 246.25(b)(3) 7 CFR 246.7(e)(4)

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment H. Data Transmittal Worksheet	H. Data Transmittal Worksheet Revised 11.27.19.docx	Yes	Yes	Fillable Fileable
Other-Appendix I. Nutritional Risk Worksheet	I. Nutritional Risk Crosswalk.docx	No		Paper Only
Other-Appendix J. Contact Request Form	J. Contact Request Form.docx	No		Paper Only
Other-Appendix M. Telephone Script for Follow-up Calls After Data Submission	M. Telephone Script for Follow-up Calls After Data Submission.docx	No		Paper 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: 360

Number of Respondents for Small Entity: 34

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,392	1,392
Annual IC Time Burden (Hours)	629	629
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix C. Notification Letter for Guidance to WIC State Agencies	C. Notification Letter for Guidance to WIC State Agencies.docx	08/29/2019
Appendix D. Guidance for WIC State Agencies Providing Participant Data	D. Guidance for WIC State Agencies Providing Participant Data Revised 11.27.19.docx	11/27/2019
Appendix K. Sample Reminder Email to WIC State Agencies	K. Sample Reminder Email to WIC State Agencies.docx	08/29/2019
Appendix L. Sample Follow-Up Emal to State Agencies	L. Sample Follow-Up Email to State Agencies.docx	06/11/2020

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