Information Collection

Caregivers of Former WIC Children (Individuals/Households)

IC 203577 under ICR 202109-0584-001 · OMB 0584-0580.

⚠️ Notice: This information collection may be referencing outdated material.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

2022-04-28 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
App A1 Year 9 Study Consent Form - English - Clean.docx	Other-App A1 Year 9 Study Consent Fo
App A1 Year 9 Study Consent Form - English - Clean.docx	Other-App A1 Year 9 Study Consent Fo
App A2 Year 9 Study Consent Form - Spanish - Clean.docx	Other-App A2 Year 9 Study Consent Fo
App A2 Year 9 Study Consent Form - Spanish - Clean.docx	Other-App A2 Year 9 Study Consent Fo
App B1. Study Extension Letter - English - clean.docx	Other-App B1. Study Extension Letter
App B1. Study Extension Letter - English - clean.docx	Other-App B1. Study Extension Letter
App B2. Study Extension Letter - Spanish 062421.docx	Other-App B2. Study Extension Letter
App B2. Study Extension Letter - Spanish 062421.docx	Other-App B2. Study Extension Letter
App_C1. Contact Information Form - English.docx	Other-App_C1. Contact Information Fo
App_C1. Contact Information Form - English.docx	Other-App_C1. Contact Information Fo
App_C2. Contact Information Form - Spanish.docx	Other-App_C2. Contact Information Fo
App_C2. Contact Information Form - Spanish.docx	Other-App_C2. Contact Information Fo
App_D1. Contact Information Form Reminder- English.docx	Other-App_D1. Contact Information Fo
App_D1. Contact Information Form Reminder- English.docx	Other-App_D1. Contact Information Fo
App_D2. Contact Information Form Reminder- Spanish.docx	Other-App_D2. Contact Information Fo
App_D2. Contact Information Form Reminder- Spanish.docx	Other-App_D2. Contact Information Fo
App_E1. Year 9 Interview Advance Letter - English.docx	Other-App_E1. Year 9 Interview Advan
App_E1. Year 9 Interview Advance Letter - English.docx	Other-App_E1. Year 9 Interview Advan
App_E2. Year 9 Interview Advance Letter- Spanish.docx	Other-App_E2. Year 9 Interview Advan
App_E2. Year 9 Interview Advance Letter- Spanish.docx	Other-App_E2. Year 9 Interview Advan
App_F1. Year 9 telephone interview - English 2_9_21.docx	Other-App_F1. Year 9 telephone inter
App_F1. Year 9 telephone interview - English 2_9_21.docx	Other-App_F1. Year 9 telephone inter
App_F2.Year 9 telephone interview - Spanish 2-9-21_.docx	Other-App_F2.Year 9 telephone interv
App_F2.Year 9 telephone interview - Spanish 2-9-21_.docx	Other-App_F2.Year 9 telephone interv
App_F3.Year 9 replicate dietary intake interview - English.docx	Other-App_F3.Year 9 replicate dietar
App_F3.Year 9 replicate dietary intake interview - English.docx	Other-App_F3.Year 9 replicate dietar
App_F4. Year 9 replicate dietary intake interview - Spanish.docx	Other-App_F4. Year 9 replicate dieta
App_F4. Year 9 replicate dietary intake interview - Spanish.docx	Other-App_F4. Year 9 replicate dieta
App_H1.Year 9 HW measurement card - English.docx	Other-App_H1.Year 9 HW measurement c
App_H1.Year 9 HW measurement card - English.docx	Other-App_H1.Year 9 HW measurement c
App_H2.Year 9 HW measurement card - Spanish.docx	Other-App_H2.Year 9 HW measurement c
App_H2.Year 9 HW measurement card - Spanish.docx	Other-App_H2.Year 9 HW measurement c
App_J1.Year 9 text or email provider measures - English.docx	Other-App_J1.Year 9 text or email pr
App_J1.Year 9 text or email provider measures - English.docx	Other-App_J1.Year 9 text or email pr
App_J2.Year 9 text or email provider measures - Spanish.docx	Other-App_J2.Year 9 text or email pr
App_J2.Year 9 text or email provider measures - Spanish.docx	Other-App_J2.Year 9 text or email pr
App_G1a.Reminders for Year 9 interview from Study Liaison - English.docx App_G1a.Reminders for Year 9 interview from Study Liaison - English	IC Document
App_G1a.Reminders for Year 9 interview from Study Liaison - English.docx App_G1a.Reminders for Year 9 interview from Study Liaison - English	IC Document
App_G1b.Reminders for Year 9 interview from Study Liaison - Spanish.docx App_G1b.Reminders for Year 9 interview from Study Liaison - Spanish	IC Document
App_G1b.Reminders for Year 9 interview from Study Liaison - Spanish.docx App_G1b.Reminders for Year 9 interview from Study Liaison - Spanish	IC Document
App_G2a.Reminders for Year 9 non-locatable active interview - English.docx App_G2a.Reminders for Year 9 non-locatable active interview - English	IC Document
App_G2a.Reminders for Year 9 non-locatable active interview - English.docx App_G2a.Reminders for Year 9 non-locatable active interview - English	IC Document
App_G2b.Reminders for Year 9 non-locatable active interview - Spanish.docx App_G2b.Reminders for Year 9 non-locatable active interview - Spanish	IC Document
App_G2b.Reminders for Year 9 non-locatable active interview - Spanish.docx App_G2b.Reminders for Year 9 non-locatable active interview - Spanish	IC Document
App_G3a.Reminders for Year 9 study participation refusal conversion - English.docx App_G3a.Reminders for Year 9 study participation refusal conversion - English	IC Document
App_G3a.Reminders for Year 9 study participation refusal conversion - English.docx App_G3a.Reminders for Year 9 study participation refusal conversion - English	IC Document
App_G3b.Reminders for Year 9 study participation refusal conversion - Spanish.docx App_G3b.Reminders for Year 9 study participation refusal conversion - Spanish	IC Document
App_G3b.Reminders for Year 9 study participation refusal conversion - Spanish.docx App_G3b.Reminders for Year 9 study participation refusal conversion - Spanish	IC Document
App_G4a.Reminders for Year 9 study participant not answering calls - English.docx App_G4a.Reminders for Year 9 study participant not answering calls - English	IC Document
App_G4a.Reminders for Year 9 study participant not answering calls - English.docx App_G4a.Reminders for Year 9 study participant not answering calls - English	IC Document
App_G4b.Reminders for Year 9 study participant not answering calls - Spanish.docx App_G4b.Reminders for Year 9 study participant not answering calls - Spanish	IC Document
App_G4b.Reminders for Year 9 study participant not answering calls - Spanish.docx App_G4b.Reminders for Year 9 study participant not answering calls - Spanish	IC Document
App_G5a.Reminders for Year 9 Interivew Telephone Research Center voicemail , first message - English.docx App_G5a.Reminders for Year 9 Interivew Telephone Research Center voicemail , first message - English	IC Document
App_G5a.Reminders for Year 9 Interivew Telephone Research Center voicemail , first message - English.docx App_G5a.Reminders for Year 9 Interivew Telephone Research Center voicemail , first message - English	IC Document
App_G5b Reminders for Year 9 Interview Telephone Research Center voicemail , first message - Spanish.docx App_G5b Reminders for Year 9 Interview Telephone Research Center voicemail , first message - Spanish	IC Document
App_G5b Reminders for Year 9 Interview Telephone Research Center voicemail , first message - Spanish.docx App_G5b Reminders for Year 9 Interview Telephone Research Center voicemail , first message - Spanish	IC Document
App_G6a.Reminders for Year 9 Interview Telephone Research Center voicemail, expiring interview - English.docx App_G6a.Reminders for Year 9 Interview Telephone Research Center voicemail, expiring interview - English	IC Document
App_G6a.Reminders for Year 9 Interview Telephone Research Center voicemail, expiring interview - English.docx App_G6a.Reminders for Year 9 Interview Telephone Research Center voicemail, expiring interview - English	IC Document
App_G6b.Reminders for Year 9 Interview Telephone Research Center voicemail, expiring interview - Spanish.docx App_G6b.Reminders for Year 9 Interview Telephone Research Center voicemail, expiring interview - Spanish	IC Document
App_G6b.Reminders for Year 9 Interview Telephone Research Center voicemail, expiring interview - Spanish.docx App_G6b.Reminders for Year 9 Interview Telephone Research Center voicemail, expiring interview - Spanish	IC Document
App_I1.Height and weight reminders - English.docx App_I1.Height and weight reminders - English	IC Document
App_I1.Height and weight reminders - English.docx App_I1.Height and weight reminders - English	IC Document
App_I2.Height and weight reminders - Spanish.docx App_I2.Height and weight reminders - Spanish	IC Document
App_I2.Height and weight reminders - Spanish.docx App_I2.Height and weight reminders - Spanish	IC Document
App_K1.Year 9 thank you - English.docx App_K1.Year 9 thank you - English	IC Document
App_K1.Year 9 thank you - English.docx App_K1.Year 9 thank you - English	IC Document
App_K2.Year 9 thank you - Spanish.docx App_K2.Year 9 thank you - Spanish	IC Document
App_K2.Year 9 thank you - Spanish.docx App_K2.Year 9 thank you - Spanish	IC Document
App_L1.Birthday card respondent year 9 - English.docx App_L1.Birthday card respondent year 9 - English	IC Document
App_L1.Birthday card respondent year 9 - English.docx App_L1.Birthday card respondent year 9 - English	IC Document
App_L2.Birthday card respondent year 9 - Spanish.docx App_L2.Birthday card respondent year 9 - Spanish	IC Document
App_L2.Birthday card respondent year 9 - Spanish.docx App_L2.Birthday card respondent year 9 - Spanish	IC Document
App_M1.Birthday card child age 9 - English.docx App_M1.Birthday card child age 9 - English	IC Document
App_M1.Birthday card child age 9 - English.docx App_M1.Birthday card child age 9 - English	IC Document
App_M2.Birthday card child age 9 - Spanish.docx App_M2.Birthday card child age 9 - Spanish	IC Document
App_M2.Birthday card child age 9 - Spanish.docx App_M2.Birthday card child age 9 - 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-App A1 Year 9 Study Consent Form - English - Clean	App A1 Year 9 Study Consent Form - English - Clean.docx	Yes	No	Paper Only
Other-App A2 Year 9 Study Consent Form - Spanish - Clean	App A2 Year 9 Study Consent Form - Spanish - Clean.docx	Yes	No	Paper Only
Other-App B1. Study Extension Letter - English - clean	App B1. Study Extension Letter - English - clean.docx	Yes	No	Paper Only
Other-App B2. Study Extension Letter - Spanish 062421	App B2. Study Extension Letter - Spanish 062421.docx	Yes	No	Paper Only
Other-App_C1. Contact Information Form - English	App_C1. Contact Information Form - English.docx	Yes	No	Paper Only
Other-App_C2. Contact Information Form - Spanish	App_C2. Contact Information Form - Spanish.docx	Yes	No	Paper Only
Other-App_D1. Contact Information Form Reminder- English	App_D1. Contact Information Form Reminder- English.docx	Yes	Yes	Fillable Fileable
Other-App_D2. Contact Information Form Reminder- Spanish	App_D2. Contact Information Form Reminder- Spanish.docx	Yes	Yes	Fillable Fileable
Other-App_E1. Year 9 Interview Advance Letter - English	App_E1. Year 9 Interview Advance Letter - English.docx	No		Paper Only
Other-App_E2. Year 9 Interview Advance Letter- Spanish	App_E2. Year 9 Interview Advance Letter- Spanish.docx	No		Paper Only
Other-App_F1. Year 9 telephone interview - English 2_9_21	App_F1. Year 9 telephone interview - English 2_9_21.docx	Yes	Yes	Fillable Fileable
Other-App_F2.Year 9 telephone interview - Spanish 2-9-21_	App_F2.Year 9 telephone interview - Spanish 2-9-21_.docx	Yes	Yes	Fillable Fileable
Other-App_F3.Year 9 replicate dietary intake interview - English	App_F3.Year 9 replicate dietary intake interview - English.docx	Yes	Yes	Fillable Fileable
Other-App_F4. Year 9 replicate dietary intake interview - Spanish	App_F4. Year 9 replicate dietary intake interview - Spanish.docx	Yes	Yes	Fillable Fileable
Other-App_H1.Year 9 HW measurement card - English	App_H1.Year 9 HW measurement card - English.docx	No		Paper Only
Other-App_H2.Year 9 HW measurement card - Spanish	App_H2.Year 9 HW measurement card - Spanish.docx	No		Paper Only
Other-App_J1.Year 9 text or email provider measures - English	App_J1.Year 9 text or email provider measures - English.docx	Yes	Yes	Fillable Fileable
Other-App_J2.Year 9 text or email provider measures - Spanish	App_J2.Year 9 text or email provider measures - Spanish.docx	Yes	Yes	Fillable Fileable

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: 2,668

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	19,585	-14,797	34,382
Annual IC Time Burden (Hours)	2,860	-1,666	4,526
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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