OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

WIC State Agency Evaluations

IC 209949 under ICR 201702-0584-001 · OMB 0584-0591.

Documents and Forms
Document Name
Document Type
Other-Attachment G Gold Application
Instruction
Instruction
Other-Attachment J Gold Evaluation W
Other-Attachment K PremElite Applica
Instruction
Instruction
Other-Attachment N PremElite Evaluat
Other-Attachment O LSA-FAQ-Page
Information Collection (IC) Details

View Information Collection (IC)

WIC State Agency Evaluations
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Attachment G Gold Application Attachment G Gold Application.docx [email protected] Yes Yes Fillable Fileable Signable
Instruction Attachment H Gold Application Instructions.docx [email protected] Yes Yes Printable Only
Instruction Attachment I Gold Evaluation Instructions.docx [email protected] Yes Yes Printable Only
Other-Attachment J Gold Evaluation Worksheet Attachment J Gold Evaluation Worksheet.docx [email protected] Yes Yes Fillable Fileable Signable
Other-Attachment K PremElite Application Attachment K PremElite Application.docx [email protected] Yes Yes Fillable Fileable Signable
Instruction Attachment L PremElite Application Instructions.docx [email protected] Yes Yes Printable Only
Instruction Attachment M PremElite Evaluation Instructions.docx [email protected] Yes Yes Printable Only
Other-Attachment N PremElite Evaluation Worksheet Attachment N PremElite Evaluation Worksheet.docx [email protected] Yes Yes Fillable Fileable Signable
Other-Attachment O LSA-FAQ-Page Attachment O LSA-FAQ-Page.pdf [email protected] Yes Yes Printable Only

Income Security Food and Nutrition Assistance

 

90 0
   
State, Local, and Tribal Governments
 
   100 %

  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 363 0 0 -244 0 607
Annual IC Time Burden (Hours) 435 0 0 -293 0 728
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.