View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

WIC Participant
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-App.E.1_Eng.Screening_Enrollment.Participant.Interview. Yes Yes Fillable Fileable
Other-App.E.2_Span.Screening_Enrollment.Participant.Interview Yes Yes Fillable Fileable
Other-App.F.1_Eng.Prenatal Enrollment Package.Letter No   Paper Only
Other-App.F.2_Span.Prenatal Enrollment Package.Letter No   Paper Only
Other-App.G 1_Eng Postnatal Enrollment Package Letter No   Paper Only
Other-App.G 2_Span Postnatal Enrollment Package Letter No   Paper Only
Other-App.I.1_Eng.Prental Participant Interview Yes Yes Fillable Fileable
Other-App.I.2_Span.Prenatal Participant Interview Yes Yes Fillable Fileable
Other-App.J.1_Eng.1 Month Participant Interview Yes Yes Fillable Fileable
Other-App.J.2_Span.1 Month Participant Interview Yes Yes Fillable Fileable
Other-App.K.1_Eng.3 Month Participant Interview Yes Yes Fillable Fileable
Other-App.K.2_Span.3 Month Participant Interview Yes Yes Fillable Fileable
Other-App.L.1_Eng.5 Month Participant Interview Yes Yes Fillable Fileable
Other-App.L.2_Span.5 Month Participant Interview Yes Yes Fillable Fileable
Other-App.M.1_Eng.7 Month Participant Interview Yes Yes Fillable Fileable
Other-App.M.2_Span.7 Month Participant Interview Yes Yes Fillable Fileable
Other-App.N.1_Eng.9 Month Participant Interview Yes Yes Fillable Fileable
Other-App.N.2_Span.9 Month Participant Interview Yes Yes Fillable Fileable
Other-App.O.1_Eng.11 Month Participant Interview Yes Yes Fillable Fileable
Other-App.O.2_Span.11 Month Participant Interview Yes Yes Fillable Fileable
Other-App.P.1_Eng.13 Month Participant Interview Yes Yes Fillable Fileable
Other-App.P.2_Span.13 Month Participant Interview Yes Yes Fillable Fileable
Other-App.Q.1_Eng.15 Month Participant Interview Yes Yes Fillable Fileable
Other-App.Q.2_Span.15 Month Participant Interview Yes Yes Fillable Fileable
Other-App.R.1_Eng.18 Month Participant Interview Yes Yes Fillable Fileable
Other-App.R.2_Span.18 Month Participant Interview Yes Yes Fillable Fileable
Other-App.S.1_Eng.24 Month Participant Interview Yes Yes Fillable Fileable
Other-App.S.2_Span.24 Month Participant Interview Yes Yes Fillable Fileable
Other-App.T.1_Eng.Baseline module.Participant.Interview Yes Yes Fillable Fileable
Other-App.T.2_Span.Baseline module.Participant.Interview Yes Yes Fillable Fileable
Other-App.U.1_Eng.New Caregiver module.Participant.Interview Yes Yes Fillable Fileable
Other-App.U.2_Span.New Caregiver module.Participant.Interview Yes Yes Fillable Fileable
Other-App.V.1 Eng Automated Multiple Pass Method 24HR.Module.Screenshots (revised) Yes Yes Fillable Fileable
Other-App.DD.1_Eng.HomeHealthcareAgency.LengthWeight.Form No   Paper Only
Other-App.DD.2_Span.HomeHealthcareAgency.LengthWeight.Form No   Paper Only
Other-App.EE.1_Eng.Home Health Visit Script.LengthWeight No   Paper Only
Other-App.EE.2_Span.Home Health Visit Script.LengthWeight No   Paper Only
Other-App V 2_Span Automated Multiple Pass Method 24HR Module Screenshots Yes Yes Fillable Fileable
Other-HIPAA Consent Letter English No   Paper Only
Other-HIPAA Consent Letter Spanish No   Paper Only

Income Security Food and Nutrition Assistance

Privacy Act of 1974  5 FR 552

4,468 0
   
Individuals or Households
 
   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 20,555 0 1,888 0 0 18,667
Annual IC Time Burden (Hours) 4,463 0 33 0 0 4,430
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
App.A.1_Eng.WIC Poster 12/18/2012
App.A.2_Span.WIC Poster 12/18/2012
App.B.1_Eng.Participant Flyer 12/18/2012
App.B.2_Span.Participant Flyer 12/18/2012
App.H 1_Eng Post Birth HIPAA Letter 12/18/2012
App.H 2_Span Post Birth HIPAA Letter 12/18/2012
App.Y.1_Eng_Core Participant Informed Consent 05/23/2013
App.Y.2_Span_Core Participant Informed Consent 05/23/2013
App.Z.1_Eng_Supplemental Participant Consent 05/23/2013
App.Z.2_Span_Supplemental Participant Consent 05/23/2013
App.NN.1_Eng.Participant Reminder Scripts 12/18/2012
App.NN.2_Span.Participant Reminder Scripts 12/18/2012
App.OO.1_Eng.Thankyou Letter 12/18/2012
App.OO.2_Span.Thankyou Letter 12/18/2012
App.TT.Confidentiality & Nondisclosure Agreement 12/18/2012
App.W.1_Eng 13 Month FoodModelBooklet.Letter 12/19/2012
App.W.2_Span 13 Month FoodModelBooklet.Letter 12/19/2012
App.X.1_Eng Note sheet for AMPM.docx 12/19/2012
App.X.2_Span Note sheet for AMPM 12/19/2012
Change Justification Memo HIPAA Incentive 04/10/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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