Information Collection

Caregivers of Former WIC Children (Individuals/Households)

IC 203577 under ICR 202103-0584-002 · OMB 0584-0580.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0580 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App_A1.Study extension consent age 6 - English 8.23.18.docx	Other-Appendix A1 Study Extension Co
App_A1.Study extension consent age 6 - English 8.23.18.docx	Other-Appendix A1 Study Extension Co
App_A2.Study extension consent age 6 - Spanish 8.23.18.docx	Other-Appendix A2 Study Extension Co
App_A2.Study extension consent age 6 - Spanish 8.23.18.docx	Other-Appendix A2 Study Extension Co
App_B1.Study extension letter - English 8.23.18.docx	Other-Appendix B1 Study Extension Le
App_B1.Study extension letter - English 8.23.18.docx	Other-Appendix B1 Study Extension Le
App_B2.Study extension letter - Spanish 8.23.18.docx	Other-Appendix B2 Study Extension Le
App_B2.Study extension letter - Spanish 8.23.18.docx	Other-Appendix B2 Study Extension Le
App_C1.72-month advance letter - English 8.24.18.docx	Other-Appendix C1 72-month Advance L
App_C1.72-month advance letter - English 8.24.18.docx	Other-Appendix C1 72-month Advance L
App_C2.72-month advance letter - Spanish 8.24.18.docx	Other-Appendix C2 72-month Advance L
App_C2.72-month advance letter - Spanish 8.24.18.docx	Other-Appendix C2 72-month Advance L
App_D1.72-month telephone interview - English 10-8-18.docx	Other-Appendix D1 72-month Telephone
App_D1.72-month telephone interview - English 10-8-18.docx	Other-Appendix D1 72-month Telephone
App_D2.72-month telephone interview - Spanish 10-8-18.docx	Other-Appendix D2 72-month Telephone
App_D2.72-month telephone interview - Spanish 10-8-18.docx	Other-Appendix D2 72-month Telephone
App_D3.72-month replicate dietary intake interview - English 10-8-18.docx	Other-Appendix D3 72-month Replicate
App_D3.72-month replicate dietary intake interview - English 10-8-18.docx	Other-Appendix D3 72-month Replicate
App_D4.72-month replicate dietary intake interview - Spanish 10-8-18.docx	Other-Appendix D4 72-month Replicate
App_D4.72-month replicate dietary intake interview - Spanish 10-8-18.docx	Other-Appendix D4 72-month Replicate
App_F1.72-month HW measurement card - English 10-8-18.docx	Other-Appendix F1 72-month H/W Measu
App_F1.72-month HW measurement card - English 10-8-18.docx	Other-Appendix F1 72-month H/W Measu
App_F2.72-month HW measurement card - Spanish 10-8-18.docx	Other-Appendix F2 72-month H/W Measu
App_F2.72-month HW measurement card - Spanish 10-8-18.docx	Other-Appendix F2 72-month H/W Measu
App_H1.72-month text or email provider measures - English 8.24.18.docx	Other-Appendix H1 72-month Text or E
App_H1.72-month text or email provider measures - English 8.24.18.docx	Other-Appendix H1 72-month Text or E
App_H2.72-month text or email provider measures - Spanish 8.24.18.docx	Other-Appendix H2 72-month Text or E
App_H2.72-month text or email provider measures - Spanish 8.24.18.docx	Other-Appendix H2 72-month Text or E
Appendix D5 Contact Information Form - English.docx	Other-Appendix D5 Contact Informatio
Appendix D5 Contact Information Form - English.docx	Other-Appendix D5 Contact Informatio
Appendix D6 Contact Information Form - Spanish.docx	Other-Appendix D6 Contact Informatio
Appendix D6 Contact Information Form - Spanish.docx	Other-Appendix D6 Contact Informatio
App_E1a.Reminders for interview from Study Liaison - English 10.1.18.docx Appendix E1a Reminders for Interview from Study Liaison - English	IC Document
App_E1a.Reminders for interview from Study Liaison - English 10.1.18.docx Appendix E1a Reminders for Interview from Study Liaison - English	IC Document
App_E1b.Reminders for interview from Study Liaison - Spanish 10.1.18.docx Appendix E1b Reminders for Interview from Study Liaison - Spanish	IC Document
App_E1b.Reminders for interview from Study Liaison - Spanish 10.1.18.docx Appendix E1b Reminders for Interview from Study Liaison - Spanish	IC Document
App_E2a.Reminders for non-locatable active interview - English 10.1.18.docx Appendix E2a Reminders for Non-Locatable Active Interview - English	IC Document
App_E2a.Reminders for non-locatable active interview - English 10.1.18.docx Appendix E2a Reminders for Non-Locatable Active Interview - English	IC Document
App_E2b.Reminders for non-locatable active interview - Spanish 10.1.18.docx Appendix E2b Reminders for Non-Locatable Active Interview - Spanish	IC Document
App_E2b.Reminders for non-locatable active interview - Spanish 10.1.18.docx Appendix E2b Reminders for Non-Locatable Active Interview - Spanish	IC Document
App_E3a.Reminders for study participation refusal conversion - English 10.1.18.docx Appendix E3a Reminders for Study Participation Refusal Conversion - English	IC Document
App_E3a.Reminders for study participation refusal conversion - English 10.1.18.docx Appendix E3a Reminders for Study Participation Refusal Conversion - English	IC Document
App_E3b.Reminders for study participation refusal conversion - Spanish 10.1.18.docx Appendix E3b Reminders for Study Participation Refusal Conversion - Spanish	IC Document
App_E3b.Reminders for study participation refusal conversion - Spanish 10.1.18.docx Appendix E3b Reminders for Study Participation Refusal Conversion - Spanish	IC Document
App_E4a.Reminders for study participation not answering calls - English 10.1.18.docx Appendix E4a Reminders for Study Participation Not Answering Calls - English	IC Document
App_E4a.Reminders for study participation not answering calls - English 10.1.18.docx Appendix E4a Reminders for Study Participation Not Answering Calls - English	IC Document
App_E4b.Reminders for study participation not answering calls - Spanish 10.118.docx Appendix E4b Reminders for Study Participation Not Answering Calls - Spanish	IC Document
App_E4b.Reminders for study participation not answering calls - Spanish 10.118.docx Appendix E4b Reminders for Study Participation Not Answering Calls - Spanish	IC Document
App_E5a.Reminders for Telephone Research Center voicemail , first message - English 10.1.18.docx Appendix E5a Reminders for Telephone Research Center Voicemail, First Message - English	IC Document
App_E5a.Reminders for Telephone Research Center voicemail , first message - English 10.1.18.docx Appendix E5a Reminders for Telephone Research Center Voicemail, First Message - English	IC Document
App_E5b Reminders for Telephone Research Center voicemail , first message - Spanish 10.1.18.docx Appendix E5b Reminders for Telephone Research Center Voicemail, First Message - Spanish	IC Document
App_E5b Reminders for Telephone Research Center voicemail , first message - Spanish 10.1.18.docx Appendix E5b Reminders for Telephone Research Center Voicemail, First Message - Spanish	IC Document
App_E6a.Reminders for Telephone Research Center voicemail, expiring interview - English 10.1.18.docx Appendix E6a Reminders for Telephone Research Center Voicemail, Expiring Interviews - English	IC Document
App_E6a.Reminders for Telephone Research Center voicemail, expiring interview - English 10.1.18.docx Appendix E6a Reminders for Telephone Research Center Voicemail, Expiring Interviews - English	IC Document
App_E6b.Reminders for Telephone Research Center voicemail, expiring interview - Spanish 10.1.18.docx Appendix E6b Reminders for Telephone Research Center Voicemail, Expiring Interviews - Spanish	IC Document
App_E6b.Reminders for Telephone Research Center voicemail, expiring interview - Spanish 10.1.18.docx Appendix E6b Reminders for Telephone Research Center Voicemail, Expiring Interviews - Spanish	IC Document
App_G1.Height and weight reminders - English 10.1.18.docx Appendix G1 Height and Weight Reminders - English	IC Document
App_G1.Height and weight reminders - English 10.1.18.docx Appendix G1 Height and Weight Reminders - English	IC Document
App_G2.Height and weight reminders - Spanish 10.1.18.docx Appendix G2 Height and Weight Reminders - Spanish	IC Document
App_G2.Height and weight reminders - Spanish 10.1.18.docx Appendix G2 Height and Weight Reminders - Spanish	IC Document
App_I1.72-month thank you - English 10.1.8.docx Appendix I1 72-month Thank You - English	IC Document
App_I1.72-month thank you - English 10.1.8.docx Appendix I1 72-month Thank You - English	IC Document
App_I2.72-month thank you - Spanish 10.1.18.docx Appendix I2 72-month Thank You - Spanish	IC Document
App_I2.72-month thank you - Spanish 10.1.18.docx Appendix I2 72-month Thank You - Spanish	IC Document
App_J1.Birthday card respondent year 6 - English 10.1.18.docx Appendix J1 Birthday Card Respondent Year 6 - English	IC Document
App_J1.Birthday card respondent year 6 - English 10.1.18.docx Appendix J1 Birthday Card Respondent Year 6 - English	IC Document
App_J2.Birthday card respondent year 6 - Spanish 10.1.18.docx Appendix J2 Birthday Card Respondent Year 6 - Spanish	IC Document
App_J2.Birthday card respondent year 6 - Spanish 10.1.18.docx Appendix J2 Birthday Card Respondent Year 6 - Spanish	IC Document
App_K1.Birthday card child age 6 - English 10.1.18.docx Appendix K1 Birthday Card Child Age 6 - English	IC Document
App_K1.Birthday card child age 6 - English 10.1.18.docx Appendix K1 Birthday Card Child Age 6 - English	IC Document
App_K2.Birthday card child age 6 - Spanish10.1.18.docx Appendix K2 Birthday Card Child Age 6 - Spanish	IC Document
App_K2.Birthday card child age 6 - Spanish10.1.18.docx Appendix K2 Birthday Card Child Age 6 - Spanish	IC Document
Appendix T1a Birthday card respondent - English 8.24.18.docx Appendix T1a: Birthday Card Respondent - English	IC Document
Appendix T1a Birthday card respondent - English 8.24.18.docx Appendix T1a: Birthday Card Respondent - English	IC Document
Appendix T1b Birthday card respondent - Spanish 8.24.18.docx Appendix T1b Birthday Card Respondent - Spanish	IC Document
Appendix T1b Birthday card respondent - Spanish 8.24.18.docx Appendix T1b Birthday Card Respondent - Spanish	IC Document
Appendix T2a Birthday card child age 7 - English 10-20-20.docx Appendix T2a Birthday Card Child Age 7 - English	IC Document
Appendix T2a Birthday card child age 7 - English 10-20-20.docx Appendix T2a Birthday Card Child Age 7 - English	IC Document
Appendix T2b Birthday card child age 7 - Spanish 10-20-20.docx Appendix T2b Birthday Card Child Age 7 - Spanish	IC Document
Appendix T2b Birthday card child age 7 - Spanish 10-20-20.docx Appendix T2b Birthday Card Child Age 7 - Spanish	IC Document
Appendix T3a Birthday card child age 8 - English 10-20-20.docx Appendix T3a Birthday Card Child Age 8 - English	IC Document
Appendix T3a Birthday card child age 8 - English 10-20-20.docx Appendix T3a Birthday Card Child Age 8 - English	IC Document
Appendix T3b Birthday card child age 8 - Spanish 10-20-20.docx Appendix T3b Birthday Card Child Age 8 - Spanish	IC Document
Appendix T3b Birthday card child age 8 - Spanish 10-20-20.docx Appendix T3b Birthday Card Child Age 8 - Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Caregivers of Former WIC Children (Individuals/Households)

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix A1 Study Extension Consent Age 6 - English	App_A1.Study extension consent age 6 - English 8.23.18.docx	No		Paper Only
Other-Appendix A2 Study Extension Consent Age 6 - Spanish	App_A2.Study extension consent age 6 - Spanish 8.23.18.docx	No		Paper Only
Other-Appendix B1 Study Extension Letter - English	App_B1.Study extension letter - English 8.23.18.docx	No		Paper Only
Other-Appendix B2 Study Extension Letter - Spanish	App_B2.Study extension letter - Spanish 8.23.18.docx	No		Paper Only
Other-Appendix C1 72-month Advance Letter - English	App_C1.72-month advance letter - English 8.24.18.docx	No		Paper Only
Other-Appendix C2 72-month Advance Letter - Spanish	App_C2.72-month advance letter - Spanish 8.24.18.docx	No		Paper Only
Other-Appendix D1 72-month Telephone Interview - English	App_D1.72-month telephone interview - English 10-8-18.docx	Yes	Yes	Fillable Fileable
Other-Appendix D2 72-month Telephone Interview - Spanish	App_D2.72-month telephone interview - Spanish 10-8-18.docx	Yes	Yes	Fillable Fileable
Other-Appendix D3 72-month Replicate Dietary Intake Interview - English	App_D3.72-month replicate dietary intake interview - English 10-8-18.docx	Yes	Yes	Fillable Fileable
Other-Appendix D4 72-month Replicate Dietary Intake Interview - Spanish	App_D4.72-month replicate dietary intake interview - Spanish 10-8-18.docx	Yes	Yes	Fillable Fileable
Other-Appendix F1 72-month H/W Measurement Card - English	App_F1.72-month HW measurement card - English 10-8-18.docx	No		Paper Only
Other-Appendix F2 72-month H/W Measurement Card - Spanish	App_F2.72-month HW measurement card - Spanish 10-8-18.docx	No		Paper Only
Other-Appendix H1 72-month Text or Email Provider Measures - English	App_H1.72-month text or email provider measures - English 8.24.18.docx	Yes	No	Paper Only
Other-Appendix H2 72-month Text or Email Provider Measures - Spanish	App_H2.72-month text or email provider measures - Spanish 8.24.18.docx	Yes	No	Paper Only
Other-Appendix D5 Contact Information Form - English	Appendix D5 Contact Information Form - English.docx	No		Paper Only
Other-Appendix D6 Contact Information Form - Spanish	Appendix D6 Contact Information Form - Spanish.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: 2,969

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	34,382	7,373	27,009
Annual IC Time Burden (Hours)	4,526	695	3,831
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix E1a Reminders for Interview from Study Liaison - English	App_E1a.Reminders for interview from Study Liaison - English 10.1.18.docx	10/11/2018
Appendix E1b Reminders for Interview from Study Liaison - Spanish	App_E1b.Reminders for interview from Study Liaison - Spanish 10.1.18.docx	10/11/2018
Appendix E2a Reminders for Non-Locatable Active Interview - English	App_E2a.Reminders for non-locatable active interview - English 10.1.18.docx	10/11/2018
Appendix E2b Reminders for Non-Locatable Active Interview - Spanish	App_E2b.Reminders for non-locatable active interview - Spanish 10.1.18.docx	10/11/2018
Appendix E3a Reminders for Study Participation Refusal Conversion - English	App_E3a.Reminders for study participation refusal conversion - English 10.1.18.docx	10/11/2018
Appendix E3b Reminders for Study Participation Refusal Conversion - Spanish	App_E3b.Reminders for study participation refusal conversion - Spanish 10.1.18.docx	10/11/2018
Appendix E4a Reminders for Study Participation Not Answering Calls - English	App_E4a.Reminders for study participation not answering calls - English 10.1.18.docx	10/11/2018
Appendix E4b Reminders for Study Participation Not Answering Calls - Spanish	App_E4b.Reminders for study participation not answering calls - Spanish 10.118.docx	10/11/2018
Appendix E5a Reminders for Telephone Research Center Voicemail, First Message - English	App_E5a.Reminders for Telephone Research Center voicemail , first message - English 10.1.18.docx	10/11/2018
Appendix E5b Reminders for Telephone Research Center Voicemail, First Message - Spanish	App_E5b Reminders for Telephone Research Center voicemail , first message - Spanish 10.1.18.docx	10/11/2018
Appendix E6a Reminders for Telephone Research Center Voicemail, Expiring Interviews - English	App_E6a.Reminders for Telephone Research Center voicemail, expiring interview - English 10.1.18.docx	10/11/2018
Appendix E6b Reminders for Telephone Research Center Voicemail, Expiring Interviews - Spanish	App_E6b.Reminders for Telephone Research Center voicemail, expiring interview - Spanish 10.1.18.docx	10/11/2018
Appendix G1 Height and Weight Reminders - English	App_G1.Height and weight reminders - English 10.1.18.docx	10/11/2018
Appendix G2 Height and Weight Reminders - Spanish	App_G2.Height and weight reminders - Spanish 10.1.18.docx	10/11/2018
Appendix I1 72-month Thank You - English	App_I1.72-month thank you - English 10.1.8.docx	10/12/2018
Appendix I2 72-month Thank You - Spanish	App_I2.72-month thank you - Spanish 10.1.18.docx	10/12/2018
Appendix J1 Birthday Card Respondent Year 6 - English	App_J1.Birthday card respondent year 6 - English 10.1.18.docx	10/12/2018
Appendix J2 Birthday Card Respondent Year 6 - Spanish	App_J2.Birthday card respondent year 6 - Spanish 10.1.18.docx	10/12/2018
Appendix K1 Birthday Card Child Age 6 - English	App_K1.Birthday card child age 6 - English 10.1.18.docx	10/12/2018
Appendix K2 Birthday Card Child Age 6 - Spanish	App_K2.Birthday card child age 6 - Spanish10.1.18.docx	10/12/2018
Appendix T1a: Birthday Card Respondent - English	Appendix T1a Birthday card respondent - English 8.24.18.docx	03/16/2021
Appendix T1b Birthday Card Respondent - Spanish	Appendix T1b Birthday card respondent - Spanish 8.24.18.docx	03/16/2021
Appendix T2a Birthday Card Child Age 7 - English	Appendix T2a Birthday card child age 7 - English 10-20-20.docx	03/16/2021
Appendix T2b Birthday Card Child Age 7 - Spanish	Appendix T2b Birthday card child age 7 - Spanish 10-20-20.docx	03/16/2021
Appendix T3a Birthday Card Child Age 8 - English	Appendix T3a Birthday card child age 8 - English 10-20-20.docx	03/16/2021
Appendix T3b Birthday Card Child Age 8 - Spanish	Appendix T3b Birthday card child age 8 - Spanish 10-20-20.docx	03/16/2021

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