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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
State and Local Agency WIC Directors and WIC Clinic Staff - SLT
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-Appendix C1 Call with State Agency Director and Request Documents
C1_Call with SA Director and Request Documents.docx
Yes
No
Paper Only
Other-Appendix C2 Local Agency Director Survey
C2_Local Agency Director Survey.docx
Yes
Yes
Fillable Fileable
Other-Appendix C2a Local Agency Director Survey (Screenshots)
C2a_Local Agency Director Survey Screenshots.pdf
Yes
Yes
Fillable Fileable
Other-Appendix C3 Call with Local Agency Director and Request Documents
C3_Call with Local Agency Director and Request Documents.docx
Yes
No
Paper Only
Other-Appendix C4 Clinic Site Information Form
C4_Clinic Site Information Form.xlsx
Yes
Yes
Fillable Fileable
Other-Appendix C5 Site Director Interview Guide
C5_Site Director Interview Guide_4.6.21.docx
No
Paper Only
Other-Appendix C6a Identified Risks Data Collection Form
C6a_Identified Risks Data Collection Form_4.6.21.docx
No
Paper Only
Other-Appendix C7 Staff Interview Guide
C7_Staff Interview Guide_remote_4.6.21.docx
No
Paper Only
Other-Appendix G4 Telephone Call with WIC Clinic
G4_Telephone Call with WIC Clinic_remote_4.6.21.docx
Yes
No
Paper Only
Other-Appendix G5 Informed Consent for Site Director Interview
G5_Informed Consent for Site Director Interview_remote_4.6.21.docx
No
Paper Only
Other-Appendix G6 Informed Consent for Observation and Staff Interview
G6_Informed Consent for Observation and Staff Interview_remote_4.6.21.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
Food and Nutrition Assistance
Privacy Act System of Records
Title:
FNS-8 USDA/FNS Studies and Reports
FR Citation:
56 FR 19078
Number of Respondents:
252
Number of Respondents for Small Entity:
238
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
33 %
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
1,412
0
1,412
0
0
0
Annual IC Time Burden (Hours)
431
0
431
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Appendix D1 Introductory Email from FNS to SA
D1_Introductory Email from FNS to SA.docx
10/27/2020
Appendix D2 Email to SA with Info Packet and Schedule Call
D2_Email to SA with Info Packet and Schedule Call.docx
10/27/2020
Appendix E1 Introductory Email from SA to all LAs with Info Packet
E1_Introductory Email from SA to all LAs with Info Packet_AB 10212020.docx
10/27/2020
Appendix E2 Email to LA with LA Director Survey Link
E2_Email to LA with LA Director Survey Link.docx
10/27/2020
Appendix E3 Reminder Emails to Complete LA Director Survey
E3_Reminder Emails to Complete LA Director Survey.docx
10/27/2020
Appendix F1 Email to SA with LAs Selected for Site Visit
F1_Email to SA with LAs Selected for Site Visit.docx
10/27/2020
Appendix F2 Site Visit Email from SA to Selected LA
F2_Site Visit Email from SA to Selected LA_AB.docx
10/27/2020
Appendix F3 Site Visit Email to LA and Schedule Call
F3_Site Visit Email to LA and Schedule Call.docx
10/27/2020
Appendix F4 Reminder Email to Submit Nutrition Risk Assessment Documents
F4_Reminder Email to Submit Nutrition Risk Assessment Documents.docx
10/27/2020
Appendix G1 Email to LA with Selected Site Name
G1_Email to LA with Selected Site Name.docx
10/27/2020
Appendix G2 Site Visit Email from LA to WIC Clinic
G2_Site Visit Email from LA to WIC Clinic.docx
10/27/2020
Appendix G3 Site Visit Email to WIC Clinic and Schedule Call
G3_Site Visit Email to WIC Clinic and Schedule Call_remote_4.6.21.docx
04/08/2021
Appendix D3 MOU for SA
D3_MOU for SA.docx
11/23/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.