Information Collection

WIC Local Agency Applications and State Agency Evaluations - SLT

IC 209949 under ICR 202009-0584-002 · OMB 0584-0591.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0591 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment G WIC Breastfeeding Award of Excellence Gold Award Applications.pdf [email protected]	Other-Attachment G WIC Breastfeeding
Attachment H Gold Application Instructions.docx [email protected]	Instruction
Attachment K Premiere Elite Application.pdf [email protected]	Other-Attachment K WIC Breastfeeding
Attachment L Premiere Elite Application Instructions.docx [email protected]	Instruction
Attachment O Frequently Asked Questions.pdf [email protected]	Other-Attachment O Frequently Asked
Attachment I Gold Evaluation Instructions.docx	Instruction
Attachment J Gold Evaluation Worksheet.docx	Other-Attachment J Gold Evaluation W
Attachment M Premiere Evaluation Instructions.docx	Instruction
Attachment N Premeire Elite Evaluation Worksheet.docx	Other-Attachment N Premiere and Elit

IC Title:

WIC Local Agency Applications and State Agency Evaluations - SLT

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment G WIC Breastfeeding Award of Excellence Gold Award Application	Attachment G WIC Breastfeeding Award of Excellence Gold Award Applications.pdf	[email protected]	Yes	No	Fillable Printable
Instruction	Attachment H Gold Application Instructions.docx	[email protected]	Yes	No	Printable Only
Other-Attachment K WIC Breastfeeding Award of Excellence the Premiere and Elite Award Application	Attachment K Premiere Elite Application.pdf	[email protected]	Yes	No	Fillable Printable
Instruction	Attachment L Premiere Elite Application Instructions.docx	[email protected]	Yes	No	Printable Only
Other-Attachment O Frequently Asked Questions	Attachment O Frequently Asked Questions.pdf	[email protected]	Yes	No	Printable Only
Instruction	Attachment I Gold Evaluation Instructions.docx		Yes	No	Printable Only
Other-Attachment J Gold Evaluation Worksheet	Attachment J Gold Evaluation Worksheet.docx		Yes	Yes	Fillable Fileable
Instruction	Attachment M Premiere Evaluation Instructions.docx		Yes	No	Printable Only
Other-Attachment N Premiere and Elite Evaluation Worksheet	Attachment N Premeire Elite Evaluation Worksheet.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 256

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	345	-18	363
Annual IC Time Burden (Hours)	548	113	435
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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