Information Collection

WIC National Outreach Campaign Formative Focus Groups

IC 259313 under ICR 202311-0584-004 · OMB 0584-0611.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0611 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A-1 WIC Par Screener (English) UPDATED.docx	Other-Attachment A-1 WIC Par Screene
Attachment A-2 WIC Non-Par Screener (English) UPDATED.docx	Other-Attachment A-2 WIC Non-Par Scr
Attachment A-3 WIC Par Screener (Spanish) UPDATED.docx	Other-Attachment A-3 WIC Par Screene
Attachment A-4 WIC Non-Par Screener (Spanish) UPDATED.docx	Other-Attachment A-4 WIC Non-Par Scr
Attachment B-1 Confirmation Form (English) UPDATED.docx	Other-Attachment B-1 Confirmation Fo
Attachment B-2 Confirmation Form (Spanish) UPDATED.docx	Other-Attachment B-2 Confirmation Fo
Attachment C-1 Consent Form (English) UPDATED.docx	Other-Attachment C-1 Consent Form (E
Attachment C-2 Consent Form (Spanish) UPDATED.docx	Other-Attachment C-2 Consent Form (S
Attachment D-1 WIC FG Guide Participants (English) UPDATED.docx	Other-Attachment D-1 WIC FG Guide Pa
Attachment D-2 WIC FG Guide NonParticipants (English) UPDATED.docx	Other-Attachment D-2 WIC FG Guide No
Attachment D-3 WIC FG Guide Participants (Spanish) UPDATED.docx	Other-Attachment D-3 WIC FG Guide Pa
Attachment D-4 WIC FG Guide NonParticipants (Spanish) UPDATED.docx	Other-Attachment D-4 WIC FG Guide No
Fast Track Clearance WIC National Outreach Campaign Formative FGs UPDATED_4_4_23 .docx Fast Track Clearance WIC National Outreach Campaign Formative FGs UPDATED_4_4_23	IC Document
Attachment E-1 Determination Notice for Non Human Subjects Research.pdf Attachment E-1 Determination Notice for Non Human Subjects Research	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

WIC National Outreach Campaign Formative Focus Groups

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment A-1 WIC Par Screener (English) UPDATED	Attachment A-1 WIC Par Screener (English) UPDATED.docx	Yes	No	Fillable Printable
Other-Attachment A-2 WIC Non-Par Screener (English) UPDATED	Attachment A-2 WIC Non-Par Screener (English) UPDATED.docx	Yes	No	Fillable Printable
Other-Attachment A-3 WIC Par Screener (Spanish) UPDATED	Attachment A-3 WIC Par Screener (Spanish) UPDATED.docx	Yes	No	Fillable Printable
Other-Attachment A-4 WIC Non-Par Screener (Spanish) UPDATED	Attachment A-4 WIC Non-Par Screener (Spanish) UPDATED.docx	Yes	No	Fillable Printable
Other-Attachment B-1 Confirmation Form (English) UPDATED	Attachment B-1 Confirmation Form (English) UPDATED.docx	No		Paper Only
Other-Attachment B-2 Confirmation Form (Spanish) UPDATED	Attachment B-2 Confirmation Form (Spanish) UPDATED.docx	No		Paper Only
Other-Attachment C-1 Consent Form (English) UPDATED	Attachment C-1 Consent Form (English) UPDATED.docx	No		Paper Only
Other-Attachment C-2 Consent Form (Spanish) UPDATED	Attachment C-2 Consent Form (Spanish) UPDATED.docx	No		Paper Only
Other-Attachment D-1 WIC FG Guide Participants (English) UPDATED	Attachment D-1 WIC FG Guide Participants (English) UPDATED.docx	No		Paper Only
Other-Attachment D-2 WIC FG Guide NonParticipants (English) UPDATED	Attachment D-2 WIC FG Guide NonParticipants (English) UPDATED.docx	No		Paper Only
Other-Attachment D-3 WIC FG Guide Participants (Spanish) UPDATED	Attachment D-3 WIC FG Guide Participants (Spanish) UPDATED.docx	No		Paper Only
Other-Attachment D-4 WIC FG Guide NonParticipants (Spanish) UPDATED	Attachment D-4 WIC FG Guide NonParticipants (Spanish) UPDATED.docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	414	414
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Clearance WIC National Outreach Campaign Formative FGs UPDATED_4_4_23	Fast Track Clearance WIC National Outreach Campaign Formative FGs UPDATED_4_4_23 .docx	04/05/2023
Attachment E-1 Determination Notice for Non Human Subjects Research	Attachment E-1 Determination Notice for Non Human Subjects Research.pdf	04/05/2023

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