Information Collection

Web Survey

IC 203557 under ICR 201208-0584-001 · OMB 0584-0574.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0574 can be found here:

Documents and Forms

Document Name Document Type
WICBPI_App_A (final v2).docx Other-Web Survey
WICBPI_App_B (final v2).docx Appendix B: Example Screenshots of Web Survey IC Document
WICBPI_App_C (final v2).docx Appendix C: Regional Field Office Advance Letter IC Document
WICBPI_App_D (final v2).docx Appendix D: Respondent Advance Letter IC Document
WICBPI_App_E (final v2).docx Appendix E: Respondent Frequently Asked Questions IC Document
WICBPI_App_F (final v2).docx Appendix F: Respondent Email Invitations IC Document
WICBPI_App_G (final v2).docx Appendix G: Respondent Reminder Email IC Document
WICBPI_App_H (final v2).docx Appendix H: Respondent Reminder Post Card IC Document
WICBPI_App_I (final v2).docx Appendix I : Respondent Reminder Telephone Call IC Document
WICBPI_App_J (final v2).docx Appendix J: Respondent Thank You Email IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Web Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web Survey			WICBPI_App_A (final v2).docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,672	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,353	3,353
Annual IC Time Burden (Hours)	2,889	2,889
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix B: Example Screenshots of Web Survey	WICBPI_App_B (final v2).docx	08/02/2012
Appendix C: Regional Field Office Advance Letter	WICBPI_App_C (final v2).docx	08/02/2012
Appendix D: Respondent Advance Letter	WICBPI_App_D (final v2).docx	08/02/2012
Appendix E: Respondent Frequently Asked Questions	WICBPI_App_E (final v2).docx	08/02/2012
Appendix F: Respondent Email Invitations	WICBPI_App_F (final v2).docx	08/02/2012
Appendix G: Respondent Reminder Email	WICBPI_App_G (final v2).docx	08/02/2012
Appendix H: Respondent Reminder Post Card	WICBPI_App_H (final v2).docx	08/02/2012
Appendix I : Respondent Reminder Telephone Call	WICBPI_App_I (final v2).docx	08/02/2012
Appendix J: Respondent Thank You Email	WICBPI_App_J (final v2).docx	08/02/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.