State and Local WIC Staff (SLT)

OMB Approval No. 0584-0580

Approval Expires: XX/XX/20XX

APPENDIX R

Participant contact information request

Hello, this I [NAME OF LIAISON}. Thank you for all your help with Feeding My Baby Study.  We have not been able to get in touch with the participant, [NAME AND ANY OTHER AVAILABLE INFORMATION] for study interviews.  I would appreciate it very much if you can check your records and get back to me with any recent contact information you have on file for this participant. My phone number is [888-XXX-XXXX].

The Food and Nutrition Service (FNS) is collecting this information to investigate (1) the dietary practices and the health and nutritional status of the WIC ITFPS-2 children during the ninth year of life; (2) if participants who left the study were systematically different than those who continued in the study and if these study participants left WIC at the same rate as their counterparts who remained in the study. This is a voluntary collection and FNS will use the information to inform WIC service delivery. The collection does request personally identifiable information under the Privacy Act of 1974. Responses will be kept private to the extent provided by law and FNS regulations. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0580. The time required to complete this information collection is estimated to average 0.0835 hours (5 minutes) per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22314. ATTN: PRA (0584-0580). Do not return the completed form to this address.