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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
State and Local WIC-Screener, Staff, Personnel
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-App.GG_Webinar Presentation- Overview of Study
App.GG_Webinar Presentation- Overview of Study.V3.pdf
Yes
Yes
Fillable Fileable
Other-App.II_Email Invitation to State & Local WIC Administrators
App.II_Email Invitation to State & Local WIC Administrators.docx
No
Paper Only
Other-App.JJ_Voicemail Invitation to State & Local WIC Administrators
App.JJ_Voicemail Invitation to State & Local WIC Administrators.docx
No
Paper Only
Other-App.LL.1.State_Key Informant Interview
App.LL.1.State_Key Informant Interview.docx
Yes
Yes
Fillable Fileable
Other-App.LL.2.Local_Key Informant Interview
App.LL.2.Local_Key Informant Interview.docx
Yes
Yes
Fillable Fileable
Other-App.C.1_Eng.Participant Referral Script & FAX cover
App.C.1_Eng.Participant Referral Script & FAX cover.docx
No
Paper Only
Other-App.C.2_Span Participant Referral Script & FAX cover
App.C.2_Span Participant Referral Script & FAX cover.docx
No
Paper Only
Other-App.D.1_Eng.Participant Referral Form.docx
App.D.1_Eng.Participant Referral Form.docx
Yes
Yes
Fillable Fileable
Other-App.D.2_Span.Participant Referral Form.docx
App.D.2_Span.Participant Referral Form.docx
Yes
Yes
Fillable Fileable
Other-App.MM.1_Eng.Local Staff Online Survey.V2
App.MM.1_Eng.Local Staff Online Survey.V2.docx
Yes
Yes
Fillable Fileable
Other-App.MM.2_Span.Local Staff Online Survey.V2
App.MM.2_Span.Local Staff Online Survey.V2.docx
Yes
Yes
Fillable Fileable
Other-App.BB_WIC Admin Data Request
App.BB_WIC Admin Data Request.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
Food and Nutrition Assistance
Privacy Act System of Records
Title:
Privacy Act of 1974
FR Citation:
5 FR 552
Number of Respondents:
862
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
99 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
441
0
441
0
0
0
Annual IC Time Burden (Hours)
418
0
418
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Screen Shots for the Web Survey
App.MM.3_Local Staff Online Survey Sample Screen Shots.V2.docx
12/18/2012
App.FF_Feeding My Baby Brochure
App.FF_Feeding My Baby Brochure.pdf
12/18/2012
App.HH.Frequently Asked Questions
App.HH.Frequently Asked Questions.docx
12/18/2012
App.KK_Thank you letter - State Not Selected
App.KK_Thank you letter - State Not Selected.docx
12/18/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.