Information Collection

WIC Local Agency Applications - Non-Profit Organizations

IC 209947 under ICR 202302-0584-005 · OMB 0584-0591.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix H Gold Application and Instructions.pdf	Other-Appendix H: Gold Application a
Appendix K Premiere and Elite Application and Instructions.pdf	Other-Appendix K: Premiere and Elite

IC Title:

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix H: Gold Application and Instructions			Appendix H Gold Application and Instructions.pdf		Yes	Yes	Fillable Printable
Other-Appendix K: Premiere and Elite Application and Instructions			Appendix K Premiere and Elite Application and Instructions.pdf		Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11

Number of Respondents for Small Entity: 11

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	11	-2	13
Annual IC Time Burden (Hours)	22	-4	26
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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