Information Collection

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

IC 263764 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⚠️ Notice: This information collection may be referencing outdated material.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 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

IC Title:

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

Agency IC Tracking Number:

IC Status: New

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 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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
National Outreach Campaign WIC â 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.