WIC Local Agency Applications and State Agency Evaluations - SLT

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 I Gold Evaluation Instructions.docx Other-Appendix I: Gold Evaluation In
Appendix J Gold Evaluation Instructions.pdf Other-Appendix J: Gold Evaluation Wo
Appendix K Premiere and Elite Application and Instructions.pdf Other-Appendix K: Premiere and Elite
Appendix L Premiere Elite Evaluation Instructions.pdf Other-Appendix L: Premiere and Elite
Appendix M Premiere Elite Evaluation Worksheet.docx Other-Appendix M: Premiere and Elite
Appendix N WIC Breastfeeding Award of Excellence Application Page.pdf Other-Appendix N: WIC Breastfeeding

Information Collection (IC) Details

IC Title:	WIC Local Agency Applications and State Agency Evaluations - SLT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	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 I: Gold Evaluation Instructions	Appendix I Gold Evaluation Instructions.docx	Yes	Yes	Fillable Printable
Other-Appendix J: Gold Evaluation Worksheet	Appendix J Gold Evaluation Instructions.pdf	Yes	Yes	Fillable Fileable
Other-Appendix K: Premiere and Elite Application and Instructions	Appendix K Premiere and Elite Application and Instructions.pdf	Yes	Yes	Fillable Printable
Other-Appendix L: Premiere and Elite Evaluation Instructions	Appendix L Premiere Elite Evaluation Instructions.pdf	Yes	Yes	Fillable Printable
Other-Appendix M: Premiere and Elite Evaluation Worksheet	Appendix M Premiere Elite Evaluation Worksheet.docx	Yes	Yes	Fillable Printable
Other-Appendix N: WIC Breastfeeding Award of Excellence Landing Page	Appendix N WIC Breastfeeding Award of Excellence Application Page.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: 228	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	317	-28	345
Annual IC Time Burden (Hours)	492	-56	548
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.