App_Q3. Addendum B to Study Extension Summary

OMB Approval No.: 0584-0580

Approval Expires: XX/XX/20XX

Appendix Q3

ATTACHMENT B: ADDENDUM FOR STUDY EXTENSION TO AGE NINE YEARS

Administrative Data on L2FU Study Participants

During the extension period for the Feeding My Baby Study, WIC State agencies will be asked to provide administrative data for study participants who left the study before the study child’s fifth birthday from a list provided by Westat in a one-time request.

Westat Role and Responsibilities:

• Westat will provide access to its secure file-transfer (sFTP) website to the designated staff from the state agency.

• Westat will securely transmit an Excel spreadsheet with the information below as available for each participant:

1. Caregiver Name

2. Caregiver Date of Birth

3. Caregiver WIC ID

4. Child’s Name

5. Child’s Date of Birth

6. Child’s WIC ID

7. Name and State of the WIC clinic at which the participant enrolled in the study

8. Last known clinic at which the participant was receiving services

9. Caregiver’s address

10. Caregiver’s phone number(s)

11. Caregiver’s email address

12. Start date of the reference period

13. End date of the reference period

14. Blank columns for the State to enter dates during which the participant started and stopped receiving WIC benefits.

• [IF STATE AGENCY IS ABLE TO ACCEPT GRANT: As a token of appreciation, Westat will provide a monetary grant in the amount of $1,000.00

WIC State Agency Roles and Responsibilities:

• Review the administrative data for the L2FU Study participants in the Excel spreadsheet provided by Westat.

• Enter dates during which the participant, either the study child or the caregiver but not any other children, started and stopped receiving WIC benefits up to the study child’s fifth birthday, or indicate the status using the codes provided by Westat.

• Securely transmit the completed spreadsheet to Westat in a timely fashion by an agreed upon date.

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 improve 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 0.3340 hours (20 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

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