Information Collection

WIC Eligibility Customer Experience Survey

IC 269402 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Prescreening CX Survey Draft July 12.docx	Other-WIC Eligibility Customer Exper
Fast Track Clearance Submission - WIC Eligibility Customer Experience Survey 7122024.docx Fast Track Submission - WIC Eligibility Customer Experience Survey	IC Document

IC Title:

WIC Eligibility Customer Experience Survey

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WIC Eligibility Customer Experience Survey					Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22,500

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	22,500	22,500
Annual IC Time Burden (Hours)	1,875	1,875
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Submission - WIC Eligibility Customer Experience Survey		07/12/2024

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

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