Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type
Profit/Nonprofit Business	New	1836	81	0	Other-Hospital Data Request Form
					Other-Hospital Data Request Form-Spanish
					Other-Provider Data Request
					Other-Provider Data Request-Spanish
State and Local WIC-Screener, Staff, Personel Non-Response	New	122	0	0	Other-Non-Respondent Place Holder
State and Local WIC-Screener, Staff, Personnel	New	441	418	0	Other-App.GG_Webinar Presentation- Overview of Study
					Other-App.II_Email Invitation to State & Local WIC Administrators
					Other-App.JJ_Voicemail Invitation to State & Local WIC Administrators
					Other-App.LL.1.State_Key Informant Interview
					Other-App.LL.2.Local_Key Informant Interview
					Other-App.C.1_Eng.Participant Referral Script & FAX cover
					Other-App.C.2_Span Participant Referral Script & FAX cover
					Other-App.D.1_Eng.Participant Referral Form.docx
					Other-App.D.2_Span.Participant Referral Form.docx
					Other-App.MM.1_Eng.Local Staff Online Survey.V2
					Other-App.MM.2_Span.Local Staff Online Survey.V2
					Other-App.BB_WIC Admin Data Request
WIC Participant	New	18667	4426	0	Other-App.E.1_Eng.Screening_Enrollment.Participant.Interview.
					Other-App.E.2_Span.Screening_Enrollment.Participant.Interview
					Other-App.F.1_Eng.Prenatal Enrollment Package.Letter
					Other-App.F.2_Span.Prenatal Enrollment Package.Letter
					Other-App.G 1_Eng Postnatal Enrollment Package Letter
					Other-App.G 2_Span Postnatal Enrollment Package Letter
					Other-App.I.1_Eng.Prental Participant Interview
					Other-App.I.2_Span.Prenatal Participant Interview
					Other-App.J.1_Eng.1 Month Participant Interview
					Other-App.J.2_Span.1 Month Participant Interview
					Other-App.K.1_Eng.3 Month Participant Interview
					Other-App.K.2_Span.3 Month Participant Interview
					Other-App.L.1_Eng.5 Month Participant Interview
					Other-App.L.2_Span.5 Month Participant Interview
					Other-App.M.1_Eng.7 Month Participant Interview
					Other-App.M.2_Span.7 Month Participant Interview
					Other-App.N.1_Eng.9 Month Participant Interview
					Other-App.N.2_Span.9 Month Participant Interview
					Other-App.O.1_Eng.11 Month Participant Interview
					Other-App.O.2_Span.11 Month Participant Interview
					Other-App.P.1_Eng.13 Month Participant Interview
					Other-App.P.2_Span.13 Month Participant Interview
					Other-App.Q.1_Eng.15 Month Participant Interview
					Other-App.Q.2_Span.15 Month Participant Interview
					Other-App.R.1_Eng.18 Month Participant Interview
					Other-App.R.2_Span.18 Month Participant Interview
					Other-App.S.1_Eng.24 Month Participant Interview
					Other-App.S.2_Span.24 Month Participant Interview
					Other-App.T.1_Eng.Baseline module.Participant.Interview
					Other-App.T.2_Span.Baseline module.Participant.Interview
					Other-App.U.1_Eng.New Caregiver module.Participant.Interview
					Other-App.U.2_Span.New Caregiver module.Participant.Interview
					Other-App.V.1 Eng Automated Multiple Pass Method 24HR.Module.Screenshots (revised)
					Other-App.DD.1_Eng.HomeHealthcareAgency.LengthWeight.Form
					Other-App.DD.2_Span.HomeHealthcareAgency.LengthWeight.Form
					Other-App.EE.1_Eng.Home Health Visit Script.LengthWeight
					Other-App.EE.2_Span.Home Health Visit Script.LengthWeight
					Other-App V 2_Span Automated Multiple Pass Method 24HR Module Screenshots
WIC Participant Non-Response	New	13154	169	0	Other-Non-Respndent Place Holder
Total burden requested under this ICR:		34220	5094	0
To view an IC, click on IC Title