Information Collection

State WIC Agency Officials (2020 and 2022)

IC 219981 under ICR 201908-0584-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
H. Data Transmittal Worksheet Revised 11.27.19.docx Other-Attachment H. Data Transmittal
I. Nutritional Risk Crosswalk.docx Other-Appendix I. Nutritional Risk W
J. Contact Request Form.docx Other-Appendix J. Contact Request Fo
M. Telephone Script for Follow-up Calls After Data Submission.docx Other-Appendix M. Telephone Script f
C. Notification Letter for Guidance to WIC State Agencies.docx Appendix C. Notification Letter for Guidance to WIC State Agencies IC Document
D. Guidance for WIC State Agencies Providing Participant Data Revised 11.27.19.docx Appendix D. Guidance for WIC State Agencies Providing Participant Data IC Document
K. Sample Reminder Email to WIC State Agencies.docx Appendix K. Sample Reminder Email to WIC State Agencies IC Document
L. Sample Follow-Up Email to State Agencies.docx Appendix L. Sample Follow-up Email to WIC State Agencies IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State WIC Agency Officials (2020 and 2022)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Appendix M. Telephone Script for Follow-up Calls After Data Submission	M. Telephone Script for Follow-up Calls After Data Submission.docx	No		Paper Only
Other-Attachment H. Data Transmittal Worksheet	H. Data Transmittal Worksheet Revised 11.27.19.docx	Yes	Yes	Fillable Fileable
Other-Appendix I. Nutritional Risk Worksheet	I. Nutritional Risk Crosswalk.docx	No		Paper Only
Other-Appendix J. Contact Request Form	J. Contact Request Form.docx	No		Paper Only

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: 360	Number of Respondents for Small Entity: 34

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,392	180	360	852
Annual IC Time Burden (Hours)	629	54	45	530
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix C. Notification Letter for Guidance to WIC State Agencies	C. Notification Letter for Guidance to WIC State Agencies.docx	08/29/2019
Appendix D. Guidance for WIC State Agencies Providing Participant Data	D. Guidance for WIC State Agencies Providing Participant Data Revised 11.27.19.docx	11/27/2019
Appendix K. Sample Reminder Email to WIC State Agencies	K. Sample Reminder Email to WIC State Agencies.docx	08/29/2019
Appendix L. Sample Follow-up Email to WIC State Agencies	L. Sample Follow-Up Email to State Agencies.docx	11/27/2019

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