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Federal forms, ICRs, and supporting documents

Information Collection

State and Local Agency WIC Directors and WIC Clinic Staff - SLT

IC 244254 under ICR 202010-0584-009 · OMB 0584-0663.

Documents and Forms
Document Name
Document Type
Other-Appendix C1 Call with State Ag
Other-Appendix C1 Call with State Ag
Other-Appendix C2 Local Agency Direc
Other-Appendix C2 Local Agency Direc
Other-Appendix C2a Local Agency Dire
Other-Appendix C2a Local Agency Dire
Other-Appendix C3 Call with Local Ag
Other-Appendix C3 Call with Local Ag
Other-Appendix C4 Clinic Site Inform
Other-Appendix C4 Clinic Site Inform
Other-Appendix C6 Site Director Inte
Other-Appendix C5 Site Director Inte
Other-Appendix C7a Identified Risks
Other-Appendix C6a Identified Risks
Other-Appendix C8 Staff Interview Gu
Other-Appendix C7 Staff Interview Gu
Other-Appendix G4 Telephone Call wit
Other-Appendix G4 Telephone Call wit
Other-Appendix G5 Informed Consent f
Other-Appendix G5 Informed Consent f
Other-Appendix G6 Informed Consent f
Other-Appendix G6 Informed Consent f
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

State and Local Agency WIC Directors and WIC Clinic Staff - SLT
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Appendix C1 Call with State Agency Director and Request Documents C1_Call with SA Director and Request Documents.docx Yes No Paper Only
Other-Appendix C2 Local Agency Director Survey C2_Local Agency Director Survey.docx Yes Yes Fillable Fileable
Other-Appendix C2a Local Agency Director Survey (Screenshots) C2a_Local Agency Director Survey Screenshots.pdf Yes Yes Fillable Fileable
Other-Appendix C3 Call with Local Agency Director and Request Documents C3_Call with Local Agency Director and Request Documents.docx Yes No Paper Only
Other-Appendix C4 Clinic Site Information Form C4_Clinic Site Information Form.xlsx Yes Yes Fillable Fileable
Other-Appendix C5 Site Director Interview Guide C5_Site Director Interview Guide_4.6.21.docx No   Paper Only
Other-Appendix C6a Identified Risks Data Collection Form C6a_Identified Risks Data Collection Form_4.6.21.docx No   Paper Only
Other-Appendix C7 Staff Interview Guide C7_Staff Interview Guide_remote_4.6.21.docx No   Paper Only
Other-Appendix G4 Telephone Call with WIC Clinic G4_Telephone Call with WIC Clinic_remote_4.6.21.docx Yes No Paper Only
Other-Appendix G5 Informed Consent for Site Director Interview G5_Informed Consent for Site Director Interview_remote_4.6.21.docx No   Paper Only
Other-Appendix G6 Informed Consent for Observation and Staff Interview G6_Informed Consent for Observation and Staff Interview_remote_4.6.21.docx No   Paper Only

Income Security Food and Nutrition Assistance

FNS-8 USDA/FNS Studies and Reports  56 FR 19078

252 238
   
State, Local, and Tribal Governments
 
   33 %

  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 1,412 0 1,412 0 0 0
Annual IC Time Burden (Hours) 431 0 431 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix D1 Introductory Email from FNS to SA D1_Introductory Email from FNS to SA.docx 10/27/2020
Appendix D2 Email to SA with Info Packet and Schedule Call D2_Email to SA with Info Packet and Schedule Call.docx 10/27/2020
Appendix E1 Introductory Email from SA to all LAs with Info Packet E1_Introductory Email from SA to all LAs with Info Packet_AB 10212020.docx 10/27/2020
Appendix E2 Email to LA with LA Director Survey Link E2_Email to LA with LA Director Survey Link.docx 10/27/2020
Appendix E3 Reminder Emails to Complete LA Director Survey E3_Reminder Emails to Complete LA Director Survey.docx 10/27/2020
Appendix F1 Email to SA with LAs Selected for Site Visit F1_Email to SA with LAs Selected for Site Visit.docx 10/27/2020
Appendix F2 Site Visit Email from SA to Selected LA F2_Site Visit Email from SA to Selected LA_AB.docx 10/27/2020
Appendix F3 Site Visit Email to LA and Schedule Call F3_Site Visit Email to LA and Schedule Call.docx 10/27/2020
Appendix F4 Reminder Email to Submit Nutrition Risk Assessment Documents F4_Reminder Email to Submit Nutrition Risk Assessment Documents.docx 10/27/2020
Appendix G1 Email to LA with Selected Site Name G1_Email to LA with Selected Site Name.docx 10/27/2020
Appendix G2 Site Visit Email from LA to WIC Clinic G2_Site Visit Email from LA to WIC Clinic.docx 10/27/2020
Appendix G3 Site Visit Email to WIC Clinic and Schedule Call G3_Site Visit Email to WIC Clinic and Schedule Call_remote_4.6.21.docx 04/08/2021
Appendix D3 MOU for SA D3_MOU for SA.docx 11/23/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.