Information Collection

Baseline of WIC State Agency Technology

IC 249615 under ICR 202102-0584-003 · OMB 0584-0613.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0613 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
A.2 Email Notifications to WIC State Agency.docx	Other-A.2 Email Notifications to WIC
A.3 Survey.docx	Other-A.3 Survey
A.4 Post-Survey Response Phone Call.docx	Other-A.4 Post-Survey Response Phone
A.5 Post-Survey Response Email.docx	Other-A.5 Post-Survey Response Email
A.1 State agency Technology Burden Table_USDS.xlsx A.1 State agency Technology Burden Table_USDS	IC Document
State Agency Technology_OMB Clearance Memo_20210913_trackchanged_CPP.docx State Agency Technology_OMB Clearance Memo	IC Document

IC Title:

Baseline of WIC State Agency Technology

Agency IC Tracking Number:

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-A.2 Email Notifications to WIC State Agency	A.2 Email Notifications to WIC State Agency.docx	Yes	No	Printable Only
Other-A.3 Survey	A.3 Survey.docx	Yes	Yes	Fillable Fileable
Other-A.4 Post-Survey Response Phone Call	A.4 Post-Survey Response Phone Call.docx	No		Paper Only
Other-A.5 Post-Survey Response Email	A.5 Post-Survey Response Email.docx	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 89

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	205	205
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
A.1 State agency Technology Burden Table_USDS	A.1 State agency Technology Burden Table_USDS.xlsx	10/04/2021
State Agency Technology_OMB Clearance Memo	State Agency Technology_OMB Clearance Memo_20210913_trackchanged_CPP.docx	10/04/2021

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