Information Collection

Local Agency WIC Clinic Staff - Profit/Non-Profit Businesses

IC 244257 under ICR 202202-0584-001 · OMB 0584-0663.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
C1_Site Director Interview Guide.docx	Other-Appendix C1 Site Director Inte
C1_Site Director Interview Guide.docx	Other-Appendix C1 Site Director Inte
C2a_Identified Risks Data Collection Form.docx	Other-Appendix C2a Identified Risks
C2a_Identified Risks Data Collection Form.docx	Other-Appendix C2a Identified Risks
C3_Staff Interview Guide.docx	Other-Appendix C3 Staff Interview Gu
C3_Staff Interview Guide.docx	Other-Appendix C3 Staff Interview Gu
D2_Telephone Call with WIC Clinic.docx	Other-Appendix D2 Telephone Call wit
D2_Telephone Call with WIC Clinic.docx	Other-Appendix D2 Telephone Call wit
D3_Informed Consent for Site Director Interview.docx	Other-Appendix D3 Informed Consent f
D3_Informed Consent for Site Director Interview.docx	Other-Appendix D3 Informed Consent f
D4_Informed Consent for Observation and Staff Interview.docx	Other-Appendix D4 Informed Consent f
D4_Informed Consent for Observation and Staff Interview.docx	Other-Appendix D4 Informed Consent f
D1_Site Visit Email to WIC Clinic and Schedule Call.docx Appendix D1 Site Visit Email to WIC Clinic and Schedule Call	IC Document
D1_Site Visit Email to WIC Clinic and Schedule Call.docx Appendix D1 Site Visit Email to WIC Clinic and Schedule Call	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 246.7(e)

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Electronic Capability
Other-Appendix C1 Site Director Interview Guide	No	Paper Only
Other-Appendix C2a Identified Risks Data Collection Form	No	Paper Only
Other-Appendix C3 Staff Interview Guide	No	Paper Only
Other-Appendix D2 Telephone Call with WIC Clinic	No	Paper Only
Other-Appendix D3 Informed Consent for Site Director Interview	No	Paper Only
Other-Appendix D4 Informed Consent for Observation and Staff Interview	No	Paper Only

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: 9

Number of Respondents for Small Entity: 9

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	189	-372	561
Annual IC Time Burden (Hours)	73	-89	162
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix D1 Site Visit Email to WIC Clinic and Schedule Call		02/02/2022

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

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