Information Collection

State WIC Agency Officials (2016 and 2018)

IC 219981 under ICR 201601-0584-006 · OMB 0584-0609.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0609 can be found here:

Documents and Forms

Document Name Document Type
Appendix G nutritional risk worksheet sample 12.14.15.pdf Other-Appendix G Nutritional Risk Wo
Appendix K Data Transmittal Worksheet Final 1.8.16.docx Other-Appendix K Data Transmittal Wo
Appendix E wic omb guidance cover letter 12.14.15.docx Appendix E Cover Letter for Guidance to WIC State Agencies Providing Participant Data IC Document
Appendix F wic omb guidance 1.5.16.docx Appendix F Guidance for WIC State Agencies Providing Participant Data IC Document
Appendix H sample reminder email to states 12.14.15.docx Appendix H Sample Reminder Email to WIC State Agencies IC Document
Appendix I sample follow-up email to states 12.14.15.docx Appendix I Sample Follow-up Email to WIC State Agencies IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State WIC Agency Officials (2016 and 2018)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 7 CFR 246.7(e)(4) 7 CFR 246.25(b)(3)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix G Nutritional Risk Worksheet			Appendix G nutritional risk worksheet sample 12.14.15.pdf		No		Paper Only
Other-Appendix K Data Transmittal Worksheet			Appendix K Data Transmittal Worksheet Final 1.8.16.docx		Yes	Yes	Fillable Fileable

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: 90	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 94 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	852	852
Annual IC Time Burden (Hours)	530	530
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix E Cover Letter for Guidance to WIC State Agencies Providing Participant Data	Appendix E wic omb guidance cover letter 12.14.15.docx	02/03/2016
Appendix F Guidance for WIC State Agencies Providing Participant Data	Appendix F wic omb guidance 1.5.16.docx	02/03/2016
Appendix H Sample Reminder Email to WIC State Agencies	Appendix H sample reminder email to states 12.14.15.docx	02/03/2016
Appendix I Sample Follow-up Email to WIC State Agencies	Appendix I sample follow-up email to states 12.14.15.docx	02/03/2016

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