Information Collection

State and Local Agency WIC Directors and WIC Clinic Staff - SLT

IC 244254 under ICR 202010-0584-009 · OMB 0584-0663.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0663 can be found here:

2022-03-22 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
C1_Call with SA Director and Request Documents.docx	Other-Appendix C1 Call with State Ag
C1_Call with SA Director and Request Documents.docx	Other-Appendix C1 Call with State Ag
C2_Local Agency Director Survey.docx	Other-Appendix C2 Local Agency Direc
C2_Local Agency Director Survey.docx	Other-Appendix C2 Local Agency Direc
C2a_Local Agency Director Survey Screenshots.pdf	Other-Appendix C2a Local Agency Dire
C2a_Local Agency Director Survey Screenshots.pdf	Other-Appendix C2a Local Agency Dire
C3_Call with Local Agency Director and Request Documents.docx	Other-Appendix C3 Call with Local Ag
C3_Call with Local Agency Director and Request Documents.docx	Other-Appendix C3 Call with Local Ag
C4_Clinic Site Information Form.xlsx	Other-Appendix C4 Clinic Site Inform
C4_Clinic Site Information Form.xlsx	Other-Appendix C4 Clinic Site Inform
C6_Site Director Interview Guide.docx	Other-Appendix C6 Site Director Inte
C5_Site Director Interview Guide_4.6.21.docx	Other-Appendix C5 Site Director Inte
C7a_Identified Risks Data Collection Form.docx	Other-Appendix C7a Identified Risks
C6a_Identified Risks Data Collection Form_4.6.21.docx	Other-Appendix C6a Identified Risks
C8_Staff Interview Guide.docx	Other-Appendix C8 Staff Interview Gu
C7_Staff Interview Guide_remote_4.6.21.docx	Other-Appendix C7 Staff Interview Gu
G4_Telephone Call with WIC Clinic.docx	Other-Appendix G4 Telephone Call wit
G4_Telephone Call with WIC Clinic_remote_4.6.21.docx	Other-Appendix G4 Telephone Call wit
G5_Informed Consent for Site Director Interview.docx	Other-Appendix G5 Informed Consent f
G5_Informed Consent for Site Director Interview_remote_4.6.21.docx	Other-Appendix G5 Informed Consent f
G6_Informed Consent for Observation and Staff Interview.docx	Other-Appendix G6 Informed Consent f
G6_Informed Consent for Observation and Staff Interview_remote_4.6.21.docx	Other-Appendix G6 Informed Consent f
D1_Introductory Email from FNS to SA.docx Appendix D1 Introductory Email from FNS to SA	IC Document
D1_Introductory Email from FNS to SA.docx Appendix D1 Introductory Email from FNS to SA	IC Document
D2_Email to SA with Info Packet and Schedule Call.docx Appendix D2 Email to SA with Info Packet and Schedule Call	IC Document
D2_Email to SA with Info Packet and Schedule Call.docx Appendix D2 Email to SA with Info Packet and Schedule Call	IC Document
E1_Introductory Email from SA to all LAs with Info Packet_AB 10212020.docx Appendix E1 Introductory Email from SA to all LAs with Info Packet	IC Document
E1_Introductory Email from SA to all LAs with Info Packet_AB 10212020.docx Appendix E1 Introductory Email from SA to all LAs with Info Packet	IC Document
E2_Email to LA with LA Director Survey Link.docx Appendix E2 Email to LA with LA Director Survey Link	IC Document
E2_Email to LA with LA Director Survey Link.docx Appendix E2 Email to LA with LA Director Survey Link	IC Document
E3_Reminder Emails to Complete LA Director Survey.docx Appendix E3 Reminder Emails to Complete LA Director Survey	IC Document
E3_Reminder Emails to Complete LA Director Survey.docx Appendix E3 Reminder Emails to Complete LA Director Survey	IC Document
F1_Email to SA with LAs Selected for Site Visit.docx Appendix F1 Email to SA with LAs Selected for Site Visit	IC Document
F1_Email to SA with LAs Selected for Site Visit.docx Appendix F1 Email to SA with LAs Selected for Site Visit	IC Document
F2_Site Visit Email from SA to Selected LA_AB.docx Appendix F2 Site Visit Email from SA to Selected LA	IC Document
F2_Site Visit Email from SA to Selected LA_AB.docx Appendix F2 Site Visit Email from SA to Selected LA	IC Document
F3_Site Visit Email to LA and Schedule Call.docx Appendix F3 Site Visit Email to LA and Schedule Call	IC Document
F3_Site Visit Email to LA and Schedule Call.docx Appendix F3 Site Visit Email to LA and Schedule Call	IC Document
F4_Reminder Email to Submit Nutrition Risk Assessment Documents.docx Appendix F4 Reminder Email to Submit Nutrition Risk Assessment Documents	IC Document
F4_Reminder Email to Submit Nutrition Risk Assessment Documents.docx Appendix F4 Reminder Email to Submit Nutrition Risk Assessment Documents	IC Document
G1_Email to LA with Selected Site Name.docx Appendix G1 Email to LA with Selected Site Name	IC Document
G1_Email to LA with Selected Site Name.docx Appendix G1 Email to LA with Selected Site Name	IC Document
G2_Site Visit Email from LA to WIC Clinic.docx Appendix G2 Site Visit Email from LA to WIC Clinic	IC Document
G2_Site Visit Email from LA to WIC Clinic.docx Appendix G2 Site Visit Email from LA to WIC Clinic	IC Document
G3_Site Visit Email to WIC Clinic and Schedule Call.docx Appendix G3 Site Visit Email to WIC Clinic and Schedule Call	IC Document
G3_Site Visit Email to WIC Clinic and Schedule Call_remote_4.6.21.docx Appendix G3 Site Visit Email to WIC Clinic and Schedule Call	IC Document
D3_MOU for SA.docx Appendix D3 MOU for SA	IC Document
D3_MOU for SA.docx Appendix D3 MOU for SA	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State and Local Agency WIC Directors and WIC Clinic Staff - SLT

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix C1 Call with State Agency Director and Request Documents	C1_Call with SA Director and Request Documents.docx	Yes	No	Paper Only
Other-Appendix C2 Local Agency Director Survey	C2_Local Agency Director Survey.docx	Yes	Yes	Fillable Fileable
Other-Appendix C2a Local Agency Director Survey (Screenshots)	C2a_Local Agency Director Survey Screenshots.pdf	Yes	Yes	Fillable Fileable
Other-Appendix C3 Call with Local Agency Director and Request Documents	C3_Call with Local Agency Director and Request Documents.docx	Yes	No	Paper Only
Other-Appendix C4 Clinic Site Information Form	C4_Clinic Site Information Form.xlsx	Yes	Yes	Fillable Fileable
Other-Appendix C5 Site Director Interview Guide	C5_Site Director Interview Guide_4.6.21.docx	No		Paper Only
Other-Appendix C6a Identified Risks Data Collection Form	C6a_Identified Risks Data Collection Form_4.6.21.docx	No		Paper Only
Other-Appendix C7 Staff Interview Guide	C7_Staff Interview Guide_remote_4.6.21.docx	No		Paper Only
Other-Appendix G4 Telephone Call with WIC Clinic	G4_Telephone Call with WIC Clinic_remote_4.6.21.docx	Yes	No	Paper Only
Other-Appendix G5 Informed Consent for Site Director Interview	G5_Informed Consent for Site Director Interview_remote_4.6.21.docx	No		Paper Only
Other-Appendix G6 Informed Consent for Observation and Staff Interview	G6_Informed Consent for Observation and Staff Interview_remote_4.6.21.docx	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: 252

Number of Respondents for Small Entity: 238

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 33 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,412	1,412
Annual IC Time Burden (Hours)	431	431
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix D1 Introductory Email from FNS to SA	D1_Introductory Email from FNS to SA.docx	10/27/2020
Appendix D2 Email to SA with Info Packet and Schedule Call	D2_Email to SA with Info Packet and Schedule Call.docx	10/27/2020
Appendix E1 Introductory Email from SA to all LAs with Info Packet	E1_Introductory Email from SA to all LAs with Info Packet_AB 10212020.docx	10/27/2020
Appendix E2 Email to LA with LA Director Survey Link	E2_Email to LA with LA Director Survey Link.docx	10/27/2020
Appendix E3 Reminder Emails to Complete LA Director Survey	E3_Reminder Emails to Complete LA Director Survey.docx	10/27/2020
Appendix F1 Email to SA with LAs Selected for Site Visit	F1_Email to SA with LAs Selected for Site Visit.docx	10/27/2020
Appendix F2 Site Visit Email from SA to Selected LA	F2_Site Visit Email from SA to Selected LA_AB.docx	10/27/2020
Appendix F3 Site Visit Email to LA and Schedule Call	F3_Site Visit Email to LA and Schedule Call.docx	10/27/2020
Appendix F4 Reminder Email to Submit Nutrition Risk Assessment Documents	F4_Reminder Email to Submit Nutrition Risk Assessment Documents.docx	10/27/2020
Appendix G1 Email to LA with Selected Site Name	G1_Email to LA with Selected Site Name.docx	10/27/2020
Appendix G2 Site Visit Email from LA to WIC Clinic	G2_Site Visit Email from LA to WIC Clinic.docx	10/27/2020
Appendix G3 Site Visit Email to WIC Clinic and Schedule Call	G3_Site Visit Email to WIC Clinic and Schedule Call_remote_4.6.21.docx	04/08/2021
Appendix D3 MOU for SA	D3_MOU for SA.docx	11/23/2020

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