Information Collection

Baseline Collection of WIC Brand Health and Messaging

IC 261260 under ICR 202311-0584-007 · OMB 0584-0524.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0524 can be found here:

Documents and Forms

Document Name Document Type
Attachment A-1 Survey Invitation (English).docx Other-Attachment A-1 Survey Invitati
Attachment A-2 Survey Invitation (Spanish).docx Other-Attachment A-2 Survey Invitati
Attachment B-1_USDA WIC Survey (English)_rev.docx Other-Attachment B-1_USDA WIC Survey
Attachment B-2_USDA WIC Survey (Spanish)_rev.docx Other-Attachment B-2_USDA WIC Survey
Attachment B-3_USDA WIC Survey Screenshots (English)_rev.docx Other-Attachment B-3_USDA WIC Survey
Attachment B-4_USDA WIC Survey screenshots (Spanish)_rev.docx Other-Attachment B-4_USDA WIC Survey
Attachment C-1 Confidentiality Form.docx Attachment C-1 Confidentiality Form IC Document
Attachment D-1_Determination Notice for Non Human Subjects Research.pdf Attachment D-1_Determination Notice for Non Human Subjects Research IC Document
OMB Generic Clearance Memo WIC Baseline Survey_09.07.23.docx OMB Generic Clearance Memo WIC Baseline Survey_09.07.23 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Baseline Collection of WIC Brand Health and Messaging	Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Attachment A-1 Survey Invitation (English)	Attachment A-1 Survey Invitation (English).docx	Yes	Yes	Fillable Printable
Other-Attachment A-2 Survey Invitation (Spanish)	Attachment A-2 Survey Invitation (Spanish).docx	Yes	Yes	Fillable Printable
Other-Attachment B-1_USDA WIC Survey (English)_rev	Attachment B-1_USDA WIC Survey (English)_rev.docx	Yes	Yes	Fillable Fileable
Other-Attachment B-2_USDA WIC Survey (Spanish)_rev	Attachment B-2_USDA WIC Survey (Spanish)_rev.docx	Yes	Yes	Fillable Fileable
Other-Attachment B-3_USDA WIC Survey Screenshots (English)_rev	Attachment B-3_USDA WIC Survey Screenshots (English)_rev.docx	Yes	Yes	Fillable Fileable
Other-Attachment B-4_USDA WIC Survey screenshots (Spanish)_rev	Attachment B-4_USDA WIC Survey screenshots (Spanish)_rev.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: 3,750	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	16,250	16,250
Annual IC Time Burden (Hours)	2,112	2,112
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment C-1 Confidentiality Form	Attachment C-1 Confidentiality Form.docx	09/12/2023
Attachment D-1_Determination Notice for Non Human Subjects Research	Attachment D-1_Determination Notice for Non Human Subjects Research.pdf	09/12/2023
OMB Generic Clearance Memo WIC Baseline Survey_09.07.23	OMB Generic Clearance Memo WIC Baseline Survey_09.07.23.docx	09/12/2023

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