National Outreach Campaign WIC – In-depth Interviews among Healthcare Professionals.

FNS Fast Track Clearance for the Collection of Routine Customer Feedback

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Attachment A-1 WIC HCP IDI Screener -20231024.docx Other-Attachment A-1 WIC HCP IDI Scr
Attachment B-1 Confirmation Form .docx Other-Attachment B-1 Confirmation Fo
Attachment C-1 Consent Form.docx Other-Attachment C-1 Consent Form
Attachment D-1 WIC HCP IDI Guide .docx Other-Attachment D-1 WIC HCP IDI Gui
Fast Track Clearance WIC Outreach Campaign HCP IDIs 20231130-1.docx National Outreach Campaign WIC – In-depth Interviews among Healthcare Professionals - Memo IC Document
Attachment E-1 Determination Notice for Non Human Subjects Research (1).pdf Attachment E2 - IRB Determination Notice IC Document

Information Collection (IC) Details

IC Title:	National Outreach Campaign WIC – In-depth Interviews among Healthcare Professionals.	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment A-1 WIC HCP IDI Screener	Attachment A-1 WIC HCP IDI Screener -20231024.docx	Yes	Yes	Fillable Printable
Other-Attachment B-1 Confirmation Form	Attachment B-1 Confirmation Form .docx	Yes	Yes	Fillable Printable
Other-Attachment C-1 Consent Form	Attachment C-1 Consent Form.docx	Yes	Yes	Fillable Printable
Other-Attachment D-1 WIC HCP IDI Guide	Attachment D-1 WIC HCP IDI Guide .docx	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: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	103	103
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
National Outreach Campaign WIC – In-depth Interviews among Healthcare Professionals - Memo	Fast Track Clearance WIC Outreach Campaign HCP IDIs 20231130-1.docx	12/01/2023
Attachment E2 - IRB Determination Notice	Attachment E-1 Determination Notice for Non Human Subjects Research (1).pdf	12/01/2023

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