Information Collection

NSWP III (IC 2 of 2)

IC 223605 under ICR 201503-0584-004 · OMB 0584-0606.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0606 can be found here:

Documents and Forms

Document Name Document Type
Appendix A3 Revised Certification Survey.docx Other-Appendix A3 Revised Certificat
Appendix A4 Revised Denied Applicant Survey.docx Other-Appendix A4 Revised Denied App
Appendix A5 Revised Program Experiences Survey.docx Other-Appendix A5 Revised Program Ex
Appendix A6 Former WIC Participant Case Study Interview Guide.docx Other-NSWP-III Pretesting\I-H\Append
C1. Proposed Informed Consent Form Certification Survey.docx Other-Consent Form
C2. Proposed Informed Consent Form Denied Applicant Survey.docx Other-Dinied Applicant Consent Form
Generic 0584-0606_Pretesting for NSWP3 8-5-16.docx OMB Memo - NSWP III Pre-testing IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NSWP III (IC 2 of 2)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Consent Form	C1. Proposed Informed Consent Form Certification Survey.docx	No	Paper Only
Other-Dinied Applicant Consent Form	C2. Proposed Informed Consent Form Denied Applicant Survey.docx	No	Paper Only
Other-Appendix A3 Revised Certification Survey	Appendix A3 Revised Certification Survey.docx	No	Paper Only
Other-Appendix A4 Revised Denied Applicant Survey	Appendix A4 Revised Denied Applicant Survey.docx	No	Paper Only
Other-Appendix A5 Revised Program Experiences Survey	Appendix A5 Revised Program Experiences Survey.docx	No	Paper Only
Other-NSWP-III Pretesting\I-H\Appendix A6 Former WIC Participant Case Study Interview Guide	Appendix A6 Former WIC Participant Case Study Interview Guide.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,032	2,032
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB Memo - NSWP III Pre-testing	Generic 0584-0606_Pretesting for NSWP3 8-5-16.docx	09/20/2016

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