WIC Participant Diaries and IDIs

FNS Fast Track Clearance for the Collection of Routine Customer Feedback

OMB: 0584-0611

IC ID: 263785

Documents and Forms
Document Name
Document Type
Other-A-1 WIC Participant Screener (
Other-A-2 WIC Participant Screener (
Other-B-1 Diary Confirmation Form (E
Other-B-2 Diary Confirmation Form (S
Other-C-1 Diary Consent Form (Englis
Other-C-2 Diary Consent Form (Spanis
Other-D-1 WIC Participant Diary Acti
Other-D-2 WIC Participant Diary Acti
Other-E-1 IDI Confirmation Form (Eng
Other-E-2 IDI Confirmation Form (Spa
Other-F-1 IDI Consent Form (English)
Other-F-2 IDI Consent Form (Spanish)
Other-G-1 WIC Participant In-Depth I
Other-G-2 WIC Participant In-Depth I
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

WIC Participant Diaries and IDIs
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL 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) Moderator’s 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) Moderator’s Guide (Spanish) Attachment G-2 WIC Shopping In-Depth Interview Guide (Spanish) _10.24.23.docx Yes Yes Fillable Fileable

Income Security Food and Nutrition Assistance

 

720 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 720 0 0 0 0 720
Annual IC Time Burden (Hours) 225 0 0 0 0 225
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
© 2025 OMB.report | Privacy Policy