Information Collection

Baseline of WIC State Agency Technology

IC 249615 under ICR 202102-0584-003 · OMB 0584-0613.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0613 can be found here:

Documents and Forms

Document Name Document Type
A.2 Email Notifications to WIC State Agency.docx Other-A.2 Email Notifications to WIC
A.3 Survey.docx Other-A.3 Survey
A.4 Post-Survey Response Phone Call.docx Other-A.4 Post-Survey Response Phone
A.5 Post-Survey Response Email.docx Other-A.5 Post-Survey Response Email
A.1 State agency Technology Burden Table_USDS.xlsx A.1 State agency Technology Burden Table_USDS IC Document
State Agency Technology_OMB Clearance Memo_20210913_trackchanged_CPP.docx State Agency Technology_OMB Clearance Memo IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Baseline of WIC State Agency Technology	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-A.2 Email Notifications to WIC State Agency	A.2 Email Notifications to WIC State Agency.docx	Yes	No	Printable Only
Other-A.3 Survey	A.3 Survey.docx	Yes	Yes	Fillable Fileable
Other-A.4 Post-Survey Response Phone Call	A.4 Post-Survey Response Phone Call.docx	No		Paper Only
Other-A.5 Post-Survey Response Email	A.5 Post-Survey Response Email.docx	Yes	No	Printable Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 89	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	205	205
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
A.1 State agency Technology Burden Table_USDS	A.1 State agency Technology Burden Table_USDS.xlsx	10/04/2021
State Agency Technology_OMB Clearance Memo	State Agency Technology_OMB Clearance Memo_20210913_trackchanged_CPP.docx	10/04/2021

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