State, Local, or Tribal Government Responsive

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Appendix T.1.

Research study team request to WIC State agencies for WIC participant 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 contact]

From: The Research study team

Subject: Contact list for WIC participants in the WIC Modernization Evaluation

Dear [WIC State Agency Director],

As you may remember from our phone meeting in [MONTH/YEAR], the WIC Modernization Evaluation includes a one-time online survey of WIC participants in your state. This survey will take about 10 minutes to complete and is divided into three sections: (1) Participation in WIC, (2) Experience with the WIC program, and (3) Demographics. WIC participants will receive a $10 [TYPE] gift card to thank them for participating in this survey.

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].

As discussed during our initial phone meeting, this survey can be done in one of two ways:

1) Your WIC State agency fields the survey directly with WIC participants. You would contact the participants via text (when available) and email with a link to the online survey. The Mathematica team will provide your WIC State agency with all of the email and text templates to field the survey, along with the links to the survey; OR

2) Mathematica fields the survey using contact information provided by your agency and assumes full responsibility for recruiting participants, sending out the electronic survey invitations and survey links to participants, and sending follow-up reminders as needed.

What we need from you:

• A decision on whether you choose your agency or Mathematica to field the survey

• A randomly selected list of up to 2,300 WIC participants across different WIC local agencies in your State in anticipation of having participants complete the survey.

Next steps:

The Mathematica team will reach out to you via phone to answer any questions you may have, discuss how you would like proceed with fielding the survey, and provide information on how to do random selection of your WIC participants.

Questions about the survey?

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