WIC Local Agency Applications - Non-Profit Organizations

WIC Breastfeeding Award of Excellence

Documents and Forms

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

Information Collection (IC) Details

IC Title:	WIC Local Agency Applications - Non-Profit Organizations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.