Information Collection

WIC Local Agency Applications and State Agency Evaluations - SLT

IC 209949 under ICR 202009-0584-002 · OMB 0584-0591.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0591 can be found here:

Documents and Forms

Document Name Document Type
Attachment G WIC Breastfeeding Award of Excellence Gold Award Applications.pdf [email protected] Other-Attachment G WIC Breastfeeding
Attachment H Gold Application Instructions.docx [email protected] Instruction
Attachment K Premiere Elite Application.pdf [email protected] Other-Attachment K WIC Breastfeeding
Attachment L Premiere Elite Application Instructions.docx [email protected] Instruction
Attachment O Frequently Asked Questions.pdf [email protected] Other-Attachment O Frequently Asked
Attachment I Gold Evaluation Instructions.docx Instruction
Attachment J Gold Evaluation Worksheet.docx Other-Attachment J Gold Evaluation W
Attachment M Premiere Evaluation Instructions.docx Instruction
Attachment N Premeire Elite Evaluation Worksheet.docx Other-Attachment N Premiere and Elit

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	WIC Local Agency Applications and State Agency Evaluations - SLT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment G WIC Breastfeeding Award of Excellence Gold Award Application	Attachment G WIC Breastfeeding Award of Excellence Gold Award Applications.pdf	[email protected]	Yes	No	Fillable Printable
Instruction	Attachment H Gold Application Instructions.docx	[email protected]	Yes	No	Printable Only
Other-Attachment K WIC Breastfeeding Award of Excellence the Premiere and Elite Award Application	Attachment K Premiere Elite Application.pdf	[email protected]	Yes	No	Fillable Printable
Instruction	Attachment L Premiere Elite Application Instructions.docx	[email protected]	Yes	No	Printable Only
Other-Attachment O Frequently Asked Questions	Attachment O Frequently Asked Questions.pdf	[email protected]	Yes	No	Printable Only
Instruction	Attachment I Gold Evaluation Instructions.docx		Yes	No	Printable Only
Other-Attachment J Gold Evaluation Worksheet	Attachment J Gold Evaluation Worksheet.docx		Yes	Yes	Fillable Fileable
Instruction	Attachment M Premiere Evaluation Instructions.docx		Yes	No	Printable Only
Other-Attachment N Premiere and Elite Evaluation Worksheet	Attachment N Premeire Elite Evaluation Worksheet.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: 256	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	345	-18	363
Annual IC Time Burden (Hours)	548	113	435
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.