OMB Number: 0584-0524 Expiration
Date: 2/28/2026
Dear WIC State Agency Director,
Westat would like to ensure we have the most updated contact information for each State agency. Please complete the information below and return this form by January 16, 2024. Email to [email protected].
State Agency:
WIC Director:
Name:
Title/Position:
Phone:
Email:
Alternate contact, if not the Director: Another person who can provide information if the Director is not available.
Name:
Title/Position:
Phone:
Email:
Do you want this person copied on all communications?
Yes No
Information technology contact for PC 2024: Responsible for technical communications regarding PC 2024. We will contact this person on technical issues regarding submissions.
Name:
Title/Position:
Phone:
Email:
Indicate if:
State agency employee
Contractor or consultant. If contractor, specify company:
Should the main contact be copied on all technical communications?
Yes No
Nutritionist contact for PC 2024: Responsible for Nutritional Risk and Food Package Coding information.
Is the person the same as alternate contact? Yes No
(if
no, please complete fields below)
Name:
Title/Position:
Phone:
This
information is being collected from State agencies to enable the
Food and Nutrition Service (FNS) to prepare biennial reports on WIC
participant and program characteristics. This is a mandatory
collection authorized under 7 CFR §246.25(b)(3). FNS uses
the data from these reports to estimate budgets, submit civil rights
reporting, identify needs for research, and to develop and review
WIC policies and procedures. Under the Privacy Act of 1974 and
the System of Record Notice FNS-8 USDA/FNS Studies and Reports, any
personally identifying information obtained will be kept private to
the extent of the law. According to the Paperwork Reduction
Act of 1995, an agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information unless it
displays a valid OMB control number. The valid OMB control number
for this information collection is 0584-0524. The time required to
complete this information collection is estimated to average 12
minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing
this burden, to: U.S. Department of Agriculture, Food and Nutrition
Services, Office of Policy Support, 1320 Braddock Place, Alexandria,
VA 22314, ATTN: PRA (0584-0524*). Do not return the completed form
to this address.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Kim Kerson |
File Modified | 0000-00-00 |
File Created | 2023-12-12 |