State, Local, or Tribal Government Responsive

Appendix R.1.

Research study team request to WIC State agencies for WIC program staff contact list for experience survey

Public Burden Statement

This information is being collected to assist the Food and Nutrition Service to better understand the implementation and impact of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) modernization efforts on WIC State and local agencies, WIC vendors and WIC participants. This is a voluntary collection and FNS will use the information to monitor and strengthen WIC program modernization efforts. 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-[xxxx]. The time required to complete this information collection is estimated to average 2 hours per response, including the time for reviewing instructions, 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, Evidence, Analysis, and Regulatory Affairs Office, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306, ATTN: PRA (0584-xxxx). Do not return the completed form to this address.

To: WIC State agency director

From: The Research study team

Subject: Contact list for WIC agency staff to participate in the WIC Modernization Evaluation

Dear [WIC State Agency Director],

As you may remember from our phone meeting in [MONTH/YEAR], as part of the WIC & FMNP Outreach, Innovation, and Modernization Evaluation (WIC Modernization Evaluation), the study team will conduct a one-time online survey of WIC staff in your State agency.

We are looking forward to working with you to field this survey, which will start on [approximately 3 months from the date of this email].

Mathematica will reach out to staff by email, briefly describing the evaluation and the survey, providing a link to the online survey, and including a one-page study description attachment.

About the survey:

The web survey will take about 10 minutes to complete and will ask staff about their experiences with the WIC modernization activities in your State agency.

What we need from you:

A randomly selected list of up to 75 WIC staff across WIC State and local agencies and clinics (details below), sent to us via Box or other secure method by XXXX date. These WIC staff should be familiar with and be able to answer questions related to the modernization efforts and activities at the local or State agency level. This can be provided to us in whichever format is easiest for your agency (Word, Excel, etc.)

• The study team will need contact information from the WIC State agency for 75 randomly selected WIC staff, ideally broken down as follows:

1. 25 WIC State agency staff

2. 25 WIC local agency staff

3. 25 WIC clinic staff

If there are fewer than 25 staff in a category, we request contact information for all staff in that category.

Next steps:

The Mathematica team will reach out to you in [# OF DAYS/WEEKS] via phone/email to answer any questions you may have and provide information on how to handle the random selection of your WIC staff.

If you have any questions or concerns about the survey, please reply to this email or contact the Mathematica study team at [EMAIL]@mathematica-mpr.com or XXX-XXX-XXXX. You can reach the FNS project officer, Carol Dreibelbis, at [email protected].

Thank you so much for taking the time to participate in this important study!

Sincerely, Caroline Lauver, Survey Director, WIC Modernization Evaluation