Information Collection

WIC National Outreach Campaign – In-depth Interviews (IDIs) among Employees of Food Shopping Vendors

IC 271956 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⚠️ Notice: This information collection may be referencing outdated material.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
Attachment A-1 WIC VENDOR STORE MANAGER-CASHIER IDI Screener_080124.docx	Other-Attachment A-1 WIC Vendor Stor
Attachment B-1 Confirmation Form - Store Managers_08012024.docx	Other-Attachment B-2 Confirmation Fo
Attachment C-1 Consent Form - Store Managers_08012024.docx	Other-Attachment C-1 Consent Form -
Attachment C-2 Consent Form - Cashiers_08012024.docx	Other-Attachment C-@ Consent Form -
Attachment D-1 Vendor Research IDI Guide - Store Managers_08012024.docx	Other-Attachment D-1 Vendor Reasearc
Attachment D-2 Vendor Research IDI Guide - Cashiers _08012024.docx	Other-Attachment D-2 Vendor Reasearc
Attachment E-1 IRB Determination Notice - Shopping Vendor IDIs.pdf Attachment E-1 IRB Determination Notice	IC Document
Fast Track Clearance WIC Outreach Campaign Shopping Vendor_1.docx Fast Track WIC Outreach Campaign Shopping Vender 10292024	IC Document

IC Title:

WIC National Outreach Campaign â In-depth Interviews (IDIs) among Employees of Food Shopping Vendors

Agency IC Tracking Number:

IC Status: New

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-Attachment A-1 WIC Vendor Store Manager -Cashier IDI Screener	Yes	Yes	Fillable Printable
Other-Attachment B-2 Confirmation Form - Store Managers	Yes	Yes	Fillable Printable
Other-Attachment C-1 Consent Form - Store Managers	Yes	Yes	Fillable Printable
Other-Attachment C-@ Consent Form - Cashiers	Yes	Yes	Fillable Printable
Other-Attachment D-1 Vendor Reasearch IDI Guide -Store Managers	Yes	Yes	Fillable Printable
Other-Attachment D-2 Vendor Reasearch IDI Guide Cashiers	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: 1,440

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,440	1,440
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment E-1 IRB Determination Notice		10/29/2024
Fast Track WIC Outreach Campaign Shopping Vender 10292024		11/13/2024

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

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