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Federal forms, ICRs, and supporting documents

Information Collection

WIC National Outreach Campaign – In-depth Interviews (IDIs) among Employees of Food Shopping Vendors

IC 269899 under ICR 202410-0584-002 · OMB 0584-0611.

Documents and Forms
Document Name
Document Type
Other-Attachment A-1 Vendor Corporat
Other-Attachment B-1 Confirmation Fo
Other-Attachment B-2 Confirmation Fo
Other-Attachment C-1 Consent Form -
Other-Attachment C-2 Consent Form -
Other-Attachment D-1 Vendor Research
Other-Attachment D-2 Vendor Research
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

WIC National Outreach Campaign – In-depth Interviews (IDIs) among Employees of Food Shopping Vendors
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Attachment A-1 Vendor Corporate Employee IDI Screener Attachment A-1 WIC VENDOR STORE MANAGER-CASHIER IDI Screener_08132024 -1.docx Yes Yes Fillable Printable
Other-Attachment B-1 Confirmation Form - Store Managers Attachment B-1 Confirmation Form - Store Managers_08012024.docx Yes Yes Fillable Printable
Other-Attachment B-2 Confirmation Form - Cashiers Attachment B-2 Confirmation Form - Cashiers_08012024.docx Yes Yes Fillable Printable
Other-Attachment C-1 Consent Form - Store Managers Attachment C-1 Consent Form - Store Managers_08012024.docx Yes Yes Fillable Printable
Other-Attachment C-2 Consent Form - Cashiers Attachment C-2 Consent Form - Cashiers_08012024.docx Yes Yes Fillable Printable
Other-Attachment D-1 Vendor Research IDI Guide - Store Managers Attachment D-1 Vendor Research IDI Guide - Store Managers_08012024.docx Yes Yes Fillable Printable
Other-Attachment D-2 Vendor Research IDI Guide - Cashiers Attachment D-2 Vendor Research IDI Guide - Cashiers _08012024.docx Yes Yes Fillable Printable

Income Security Food and Nutrition Assistance

 

1,440 0
   
Individuals or Households
 
   0 %

  Requested 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 1,440 0 0 0 0 1,440
Annual IC Time Burden (Hours) 167 0 0 0 0 167
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment E-1 IRB Determination Notice Attachment E-1 IRB Determination Notice - Shopping Vendor IDIs.pdf 08/07/2024
Fast Track Clearance WIC Outreach Campaign Shopping Vendor_08012024.docx Fast Track Clearance WIC Outreach Campaign Shopping Vendor_08012024.docx 08/07/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.