WIC Eligibility Customer Experience Survey

OMB CONTROL NO.: 0584-0611

EXPIRATION DATE: 11/30/2025

OMB BURDEN STATEMENT: This information is being collected to assist the Food and Nutrition Service in improving the online WIC eligibility service. This collection does not request any personally identifiable information under the Privacy Act of 1974. 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 0584-0611. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions, the Privacy Act Statement, Consent Form, 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 Service, Supplemental Nutrition and Safety Programs, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306 ATTN: PRA 584-0611). Do not return the completed form to this address.

WIC Prescreening/Eligibility Tool Satisfaction Survey

1. Using this [WIC Prescreening Tool/WIC Eligibility Tool] increased my trust that the USDA’s Food and Nutrition Service is connecting eligible applicants to WIC Program services. [thumbs up/thumbs down]

2. Variable based on answer to question 1:

If thumbs up:

2a. What about this experience made the difference? Select all that apply.

• I found the information I needed.

• It was easy to complete the tool.

• It did not take too long.

• I understood the questions being asked in the tool.

• Something else. [free text option]

If thumbs down:

2b. What could have been better? Select all that apply.

• I did not find the information I needed.

• It was difficult to complete the tool.

• It took too long.

• I did not understand the questions being asked in the tool.

• Something else. [free text option]

2b part 2 (only for those who selected thumbs down). What questions do you still have about WIC eligibility and the application process?

• [Free text]

3. After using the [WIC Prescreening Tool/WIC Eligibility Tool]:

• I found out I am probably eligible, and I plan to apply for WIC.

• I found out I am probably eligible, but I do NOT plan to apply for WIC.

• I found out I am probably not eligible.

• Something else. [free text option]

4. Is there anything else you want us to know about your experience?

• [Free text]