Information Collection

WIC Participant Diaries and IDIs

IC 263785 under ICR 202410-0584-002 · OMB 0584-0611.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0611 can be found here:

2025-11-24 - Revision of a currently approved collection

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: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-A-1 WIC Participant Screener (English)	Yes	Yes	Fillable Printable
Other-A-2 WIC Participant Screener (Spanish)	Yes	Yes	Fillable Printable
Other-B-1 Diary Confirmation Form (English)	Yes	Yes	Fillable Printable
Other-B-2 Diary Confirmation Form (Spanish)	Yes	Yes	Fillable Printable
Other-C-1 Diary Consent Form (English)	Yes	Yes	Fillable Printable
Other-C-2 Diary Consent Form (Spanish)	Yes	Yes	Fillable Printable
Other-D-1 WIC Participant Diary Activity List (English)	Yes	Yes	Fillable Printable
Other-D-2 WIC Participant Diary Activity List (Spanish)	Yes	Yes	Fillable Printable
Other-E-1 IDI Confirmation Form (English	Yes	Yes	Fillable Printable
Other-E-2 IDI Confirmation Form (Spanish)	Yes	Yes	Fillable Printable
Other-F-1 IDI Consent Form (English)	Yes	Yes	Fillable Printable
Other-F-2 IDI Consent Form (Spanish)	Yes	Yes	Fillable Printable
Other-G-1 WIC Participant In-Depth Interview (IDI) Moderatorâs Guide (English)	Yes	Yes	Fillable Printable
Other-G-2 WIC Participant In-Depth Interview (IDI) Moderatorâs Guide (Spanish)	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
	Requested	Previously Approved
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		12/04/2023
H-1 IRB Determination Notice		12/04/2023

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

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