Information Collection

Caregivers of Former WIC Children (Individuals/Households)

IC 203577 under ICR 202204-0584-005 · OMB 0584-0580.

Documents and Forms

Documents and forms in this information collection
Document NameDocument 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_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_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_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)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-App A1 Year 9 Study Consent Form - English - Clean Yes No Paper Only
Other-App A2 Year 9 Study Consent Form - Spanish - Clean Yes No Paper Only
Other-App B1. Study Extension Letter - English - clean Yes No Paper Only
Other-App B2. Study Extension Letter - Spanish 062421 Yes No Paper Only
Other-App_C1. Contact Information Form - English Yes No Paper Only
Other-App_C2. Contact Information Form - Spanish Yes No Paper Only
Other-App_D1. Contact Information Form Reminder- English Yes Yes Fillable Fileable
Other-App_D2. Contact Information Form Reminder- Spanish Yes Yes Fillable Fileable
Other-App_E1. Year 9 Interview Advance Letter - English No   Paper Only
Other-App_E2. Year 9 Interview Advance Letter- Spanish No   Paper Only
Other-App_H1.Year 9 HW measurement card - English No   Paper Only
Other-App_H2.Year 9 HW measurement card - Spanish No   Paper Only
Other-App_J1.Year 9 text or email provider measures - English Yes Yes Fillable Fileable
Other-App_J2.Year 9 text or email provider measures - Spanish Yes Yes Fillable Fileable
Other-App_F1. Year 9 telephone interview - English 2_9_21 No   Paper Only
Other-App_F2.Year 9 telephone interview - Spanish 2-9-21_ No   Paper Only
Other-App_F3.Year 9 replicate dietary intake interview - English No   Paper Only
Other-App_F4. Year 9 replicate dietary intake interview - Spanish No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 19,585 0 0 0 0 19,585
Annual IC Time Burden (Hours) 2,860 0 0 0 0 2,860
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
App_G1a.Reminders for Year 9 interview from Study Liaison - English 10/15/2021
App_G1b.Reminders for Year 9 interview from Study Liaison - Spanish 10/15/2021
App_G2a.Reminders for Year 9 non-locatable active interview - English 10/15/2021
App_G2b.Reminders for Year 9 non-locatable active interview - Spanish 10/15/2021
App_G3a.Reminders for Year 9 study participation refusal conversion - English 10/15/2021
App_G3b.Reminders for Year 9 study participation refusal conversion - Spanish 10/15/2021
App_G4a.Reminders for Year 9 study participant not answering calls - English 10/15/2021
App_G4b.Reminders for Year 9 study participant not answering calls - Spanish 10/15/2021
App_G5a.Reminders for Year 9 Interivew Telephone Research Center voicemail , first message - English 10/15/2021
App_G5b Reminders for Year 9 Interview Telephone Research Center voicemail , first message - Spanish 10/15/2021
App_G6a.Reminders for Year 9 Interview Telephone Research Center voicemail, expiring interview - English 10/15/2021
App_G6b.Reminders for Year 9 Interview Telephone Research Center voicemail, expiring interview - Spanish 10/15/2021
App_I1.Height and weight reminders - English 10/15/2021
App_I2.Height and weight reminders - Spanish 10/15/2021
App_K1.Year 9 thank you - English 10/15/2021
App_K2.Year 9 thank you - Spanish 10/15/2021
App_L1.Birthday card respondent year 9 - English 10/15/2021
App_L2.Birthday card respondent year 9 - Spanish 10/15/2021
App_M1.Birthday card child age 9 - English 10/15/2021
App_M2.Birthday card child age 9 - Spanish 10/15/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].