Information Collection

WIC Participant Diaries and IDIs

IC 263785 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⚠️ Notice: This information collection may be referencing outdated material.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 Shopping Screener (English) 10.19.23_Approved.docx	Other-A-1 WIC Participant Screener (
Attachment A-2 WIC Shopping Screener (Spanish) 10.19.23_Approved.docx	Other-A-2 WIC Participant Screener (
Attachment B-1 Confirmation Form (English)_10.10.2023_Approved.docx	Other-B-1 Diary Confirmation Form (E
Attachment B-2 Confirmation Form (Spanish)_10.10.2023_Approved.docx	Other-B-2 Diary Confirmation Form (S
Attachment C-1 Consent Form (English)_10.19.2023_Approved.docx	Other-C-1 Diary Consent Form (Englis
Attachment C-2Consent Form (Spanish)_10.19.2023_Approved.docx	Other-C-2 Diary Consent Form (Spanis
Attachment D-1 WIC Shopping Diary Activity List (English) 10.10.2023_Approved.docx	Other-D-1 WIC Participant Diary Acti
Attachment D-2 WIC Shopping Diary Activity List (Spanish)_10.10.2023_Approved.docx	Other-D-2 WIC Participant Diary Acti
Attachment E-1 Confirmation Form (English)_10.10.23_Approved.docx	Other-E-1 IDI Confirmation Form (Eng
Attachment E-2 Confirmation Form (Spanish)_10.10.23_Approved.docx	Other-E-2 IDI Confirmation Form (Spa
Attachment F-1 Consent Form (English)_10.10.2023_Approved.docx	Other-F-1 IDI Consent Form (English)
Attachment F-2 Consent Form (Spanish)_10.10.2023_Approved.docx	Other-F-2 IDI Consent Form (Spanish)
Attachment G-1 WIC Shopping In-Depth Interview Guide (English) _10.24.23.docx	Other-G-1 WIC Participant In-Depth I
Attachment G-2 WIC Shopping In-Depth Interview Guide (Spanish) _10.24.23.docx	Other-G-2 WIC Participant In-Depth I
Fast Track Clearance WIC Shopping and Texting Research - 20231130.docx Fast Track Clearance WIC Shopping and Texting Research - Memo	IC Document
FHI 360 IRB Determination - Shopping Diary and IDIs.pdf H-1 IRB Determination Notice	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

WIC Participant Diaries and IDIs

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-A-1 WIC Participant Screener (English)	Attachment A-1 WIC Shopping Screener (English) 10.19.23_Approved.docx	Yes	Yes	Fillable Printable
Other-A-2 WIC Participant Screener (Spanish)	Attachment A-2 WIC Shopping Screener (Spanish) 10.19.23_Approved.docx	Yes	Yes	Fillable Printable
Other-B-1 Diary Confirmation Form (English)	Attachment B-1 Confirmation Form (English)_10.10.2023_Approved.docx	Yes	Yes	Fillable Printable
Other-B-2 Diary Confirmation Form (Spanish)	Attachment B-2 Confirmation Form (Spanish)_10.10.2023_Approved.docx	Yes	Yes	Fillable Printable
Other-C-1 Diary Consent Form (English)	Attachment C-1 Consent Form (English)_10.19.2023_Approved.docx	Yes	Yes	Fillable Printable
Other-C-2 Diary Consent Form (Spanish)	Attachment C-2Consent Form (Spanish)_10.19.2023_Approved.docx	Yes	Yes	Fillable Printable
Other-D-1 WIC Participant Diary Activity List (English)	Attachment D-1 WIC Shopping Diary Activity List (English) 10.10.2023_Approved.docx	Yes	Yes	Fillable Printable
Other-D-2 WIC Participant Diary Activity List (Spanish)	Attachment D-2 WIC Shopping Diary Activity List (Spanish)_10.10.2023_Approved.docx	Yes	Yes	Fillable Printable
Other-E-1 IDI Confirmation Form (English	Attachment E-1 Confirmation Form (English)_10.10.23_Approved.docx	Yes	Yes	Fillable Printable
Other-E-2 IDI Confirmation Form (Spanish)	Attachment E-2 Confirmation Form (Spanish)_10.10.23_Approved.docx	Yes	Yes	Fillable Printable
Other-F-1 IDI Consent Form (English)	Attachment F-1 Consent Form (English)_10.10.2023_Approved.docx	Yes	Yes	Fillable Printable
Other-F-2 IDI Consent Form (Spanish)	Attachment F-2 Consent Form (Spanish)_10.10.2023_Approved.docx	Yes	Yes	Fillable Printable
Other-G-1 WIC Participant In-Depth Interview (IDI) Moderatorâs Guide (English)	Attachment G-1 WIC Shopping In-Depth Interview Guide (English) _10.24.23.docx	Yes	Yes	Fillable Printable
Other-G-2 WIC Participant In-Depth Interview (IDI) Moderatorâs Guide (Spanish)	Attachment G-2 WIC Shopping In-Depth Interview Guide (Spanish) _10.24.23.docx	Yes	Yes	Fillable Fileable

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: 720

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	720	720
Annual IC Time Burden (Hours)	225	225
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Clearance WIC Shopping and Texting Research - Memo	Fast Track Clearance WIC Shopping and Texting Research - 20231130.docx	12/04/2023
H-1 IRB Determination Notice	FHI 360 IRB Determination - Shopping Diary and IDIs.pdf	12/04/2023

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