| Appendix B. WIC NATS OMB Burden Table |
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Responsive |
Non-responsive |
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| Respondent Category |
Type of respondents |
Instruments |
OMB Appendix Number |
Sample Size |
Number of respondents |
Frequency of response (annual) |
Total Annual responses |
Hours per response |
Total Annual Burden (hours) |
Number of
Non-respondents |
Frequency of response (annual) |
Total Annual responses |
Hours per response |
Total Annual Burden (hours) |
Grand Total Burden Estimate (hours) |
Hourly Rate (p) |
Total Annualized Cost |
| State, Local, or Tribal Government |
WIC State Agency (SA) |
Introductory Email from FNS to SA |
D1 |
13 |
10 |
1 |
10 |
0.07 |
0.67 |
3 |
1 |
3 |
0.02 |
0.05 |
0.72 |
58.88 |
42.28 |
| Email to SA with Info Packet and Schedule Call |
D2 |
13 |
10 |
1 |
10 |
0.15 |
1.50 |
3 |
1 |
3 |
0.02 |
0.05 |
1.55 |
58.88 |
91.45 |
| Call with State Agency Director and Request Documents |
C1 |
10 |
10 |
1 |
10 |
0.50 |
5.00 |
0 |
1 |
0 |
0.02 |
0.00 |
5.00 |
58.88 |
294.40 |
| SA to Submit WIC Nutrition Risk materials |
n/a |
10 |
10 |
1 |
10 |
0.50 |
5.00 |
0 |
1 |
0 |
0.02 |
0.00 |
5.00 |
58.88 |
294.40 |
| SA to Submit MIS data extract |
n/a |
10 |
10 |
2 |
20 |
2.00 |
40.00 |
0 |
2 |
0 |
0.02 |
0.00 |
40.00 |
58.88 |
2355.20 |
| MOU for SA |
D3 |
10 |
10 |
1 |
10 |
0.12 |
1.17 |
0 |
1 |
0 |
0.02 |
0.00 |
1.17 |
58.88 |
68.83 |
| Email to SA with LAs Selected for Site Visit |
F1 |
10 |
10 |
1 |
10 |
0.07 |
0.67 |
0 |
1 |
0 |
0.02 |
0.00 |
0.67 |
58.88 |
39.33 |
| SUBTOTAL OF SA |
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13 |
10 |
8.0 |
80 |
0.68 |
54.01 |
3 |
2.00 |
6 |
0.02 |
0.10 |
54.11 |
|
3185.89 |
| WIC Local Agency (LA) |
PRETEST |
n/a |
3 |
3 |
1 |
3 |
1.49 |
4.47 |
0 |
1 |
0 |
0.10 |
0.00 |
4.47 |
58.88 |
263.19 |
| Introductory Email from SA to all LAs with Info Packet |
E1 |
259 |
217 |
1 |
217 |
0.07 |
14.50 |
42 |
1 |
42 |
0.02 |
0.70 |
15.20 |
58.88 |
894.80 |
| Email to LA with LA Director Survey Link |
E2 |
259 |
155 |
1 |
155 |
0.03 |
5.18 |
104 |
1 |
104 |
0.02 |
1.74 |
6.91 |
58.88 |
407.08 |
| Reminder Emails to Complete LA Director Survey |
E3 |
104 |
62 |
2 |
124 |
0.02 |
2.07 |
42 |
2 |
84 |
0.02 |
1.40 |
3.47 |
58.88 |
204.53 |
| Local Agency Director Survey |
C2, C2a |
259 |
217 |
1 |
217 |
0.55 |
119.35 |
42 |
1 |
42 |
0.02 |
0.70 |
120.05 |
58.88 |
7068.63 |
| Site Visit Email from SA to Selected LA |
F2 |
24 |
24 |
1 |
24 |
0.03 |
0.80 |
0 |
1 |
0 |
0.02 |
0.00 |
0.80 |
58.88 |
47.20 |
| Site Visit Email to LA and Schedule Call |
F3 |
24 |
21 |
1 |
21 |
0.03 |
0.70 |
3 |
1 |
3 |
0.02 |
0.05 |
0.75 |
58.88 |
44.25 |
| Call with Local Agency Director and Request Documents |
C3 |
21 |
21 |
1 |
21 |
1.00 |
21.00 |
0 |
1 |
0 |
0.02 |
0.00 |
21.00 |
58.88 |
1236.48 |
| Clinic Site Information Form |
C4 |
21 |
21 |
1 |
21 |
1.00 |
21.00 |
0 |
1 |
0 |
0.02 |
0.00 |
21.00 |
58.88 |
1236.48 |
| LA to Submit Nutrition Risk Assessment Documents |
n/a |
21 |
13 |
1 |
13 |
0.50 |
6.50 |
8 |
1 |
8 |
0.02 |
0.13 |
6.63 |
58.88 |
390.59 |
| Reminder Email to Submit Nutrition Risk Assessment Documents |
F4 |
8 |
8 |
1 |
8 |
0.50 |
4.00 |
0 |
1 |
0 |
0.02 |
0.00 |
4.00 |
58.88 |
235.52 |
| Email to LA with Selected Site Name |
G1 |
21 |
21 |
1 |
21 |
0.08 |
1.75 |
0 |
1 |
0 |
0.02 |
0.00 |
1.75 |
58.88 |
103.25 |
| SUBTOTAL OF WIC LA |
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262 |
220 |
3.84 |
845 |
0.24 |
201.32 |
42 |
6.74 |
283 |
0.02 |
4.73 |
206.05 |
|
12131.99 |
| WIC Clinic |
PRETEST |
n/a |
1 |
1 |
1 |
1 |
3.68 |
3.68 |
0 |
1 |
0 |
0.23 |
0.00 |
3.68 |
14.91 |
54.87 |
| Site Visit Email from LA to WIC Clinic |
G2 |
24 |
24 |
1 |
24 |
0.03 |
0.80 |
0 |
1 |
0 |
0.02 |
0.00 |
0.80 |
14.91 |
11.95 |
| Site Visit Email to WIC Clinic and Schedule Call |
G3 |
24 |
21 |
1 |
21 |
0.08 |
1.75 |
3 |
1 |
3 |
0.02 |
0.05 |
1.80 |
14.91 |
26.89 |
| Telephone Call with WIC Clinic |
G4 |
21 |
21 |
1 |
21 |
1.00 |
21.00 |
0 |
1 |
0 |
0.02 |
0.00 |
21.00 |
14.91 |
313.11 |
| Informed Consent for Site Director Interview |
G5 |
21 |
21 |
1 |
21 |
0.08 |
1.75 |
0 |
1 |
0 |
0.02 |
0.00 |
1.75 |
14.91 |
26.14 |
| Site Director Interview Guide |
C6 |
21 |
21 |
1 |
21 |
0.75 |
15.75 |
0 |
1 |
0 |
0.02 |
0.00 |
15.75 |
14.91 |
234.83 |
| Finalize Plans with WIC Clinic on Day of Site Visit |
n/a |
21 |
21 |
1 |
21 |
0.25 |
5.25 |
0 |
1 |
0 |
0.02 |
0.00 |
5.25 |
14.91 |
78.28 |
| Informed Consent for Observation and Staff Interview |
G6 |
21 |
21 |
6 |
126 |
0.08 |
10.52 |
0 |
6 |
0 |
0.02 |
0.00 |
10.52 |
14.91 |
156.87 |
| Identified Risks Data Collection Form |
C7a |
21 |
21 |
6 |
126 |
0.08 |
10.52 |
0 |
6 |
0 |
0.02 |
0.00 |
10.52 |
14.91 |
156.87 |
| Staff Interview Guide |
C8 |
21 |
21 |
5 |
105 |
1.00 |
105.00 |
0 |
5 |
0 |
0.02 |
0.00 |
105.00 |
14.91 |
1565.55 |
| SUBTOTAL OF WIC CLINIC |
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25 |
22 |
22.14 |
487 |
0.36 |
176.03 |
3 |
1.00 |
3 |
0.02 |
0.05 |
176.08 |
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2625.36 |
| TOTAL STATE AND LOCAL AGENCY |
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300 |
252 |
5.60 |
1412 |
0.31 |
431.36 |
48 |
6.08 |
292 |
0.02 |
4.88 |
436.23 |
|
17943.24 |
| Business or Other For-Profit and Nonprofit Institutions |
WIC Local Agency (LA) |
PRETEST |
n/a |
5 |
2 |
1 |
2 |
1.49 |
2.98 |
3 |
1 |
3 |
0.10 |
0.30 |
3.28 |
58.88 |
193.13 |
| Introductory Email from SA to all LAs with Info Packet |
E1 |
111 |
89 |
1 |
89 |
0.07 |
5.95 |
22 |
1 |
22 |
0.02 |
0.37 |
6.31 |
58.88 |
371.69 |
| Email to LA with LA Director Survey Link |
E2 |
111 |
56 |
1 |
56 |
0.03 |
1.87 |
55 |
1 |
55 |
0.02 |
0.92 |
2.79 |
58.88 |
164.21 |
| Reminder Emails to Complete LA Director Survey |
E3 |
55 |
33 |
2 |
66 |
0.02 |
1.10 |
22 |
2 |
44 |
0.02 |
0.73 |
1.84 |
58.88 |
108.16 |
| Local Agency Director Survey |
C2, C2a |
111 |
89 |
1 |
89 |
0.55 |
48.95 |
22 |
1 |
22 |
0.02 |
0.37 |
49.32 |
58.88 |
2903.81 |
| Site Visit Email from SA to Selected LA |
F2 |
12 |
12 |
1 |
12 |
0.03 |
0.40 |
0 |
1 |
0 |
0.02 |
0.00 |
0.40 |
58.88 |
23.60 |
| Site Visit Email to LA and Schedule Call |
F3 |
12 |
9 |
1 |
9 |
0.03 |
0.30 |
3 |
1 |
3 |
0.02 |
0.05 |
0.35 |
58.88 |
20.65 |
| Call with Local Agency Director and Request Documents |
C3 |
9 |
9 |
1 |
9 |
1.00 |
9.00 |
0 |
1 |
0 |
0.02 |
0.00 |
9.00 |
58.88 |
529.92 |
| Clinic Site Information Form |
C4 |
9 |
9 |
1 |
9 |
1.00 |
9.00 |
0 |
1 |
0 |
0.02 |
0.00 |
9.00 |
58.88 |
529.92 |
| LA to Submit Nutrition Risk Assessment Documents |
n/a |
9 |
5 |
1 |
5 |
0.50 |
2.50 |
4 |
1 |
4 |
0.02 |
0.07 |
2.57 |
58.88 |
151.13 |
| Reminder Email to Submit Nutrition Risk Assessment Documents |
F4 |
4 |
4 |
1 |
4 |
0.50 |
2.00 |
0 |
1 |
0 |
0.02 |
0.00 |
2.00 |
58.88 |
117.76 |
| Email to LA with Selected Site Name |
G1 |
9 |
9 |
1 |
9 |
0.08 |
0.75 |
0 |
1 |
0 |
0.02 |
0.00 |
0.75 |
58.88 |
44.25 |
| SUBTOTAL OF WIC LA |
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116 |
91 |
3.95 |
359 |
0.24 |
84.80 |
25 |
6.12 |
153 |
0.02 |
2.81 |
87.61 |
|
5158.22 |
| WIC Clinic |
PRETEST |
n/a |
2 |
1 |
1 |
1 |
3.68 |
3.68 |
1 |
1 |
1 |
0.23 |
0.23 |
3.91 |
14.91 |
58.30 |
| Site Visit Email from LA to WIC Clinic |
G2 |
12 |
12 |
1 |
12 |
0.03 |
0.40 |
0 |
1 |
0 |
0.02 |
0.00 |
0.40 |
14.91 |
5.98 |
| Site Visit Email to WIC Clinic and Schedule Call |
G3 |
12 |
9 |
1 |
9 |
0.08 |
0.75 |
3 |
1 |
3 |
0.02 |
0.05 |
0.80 |
14.91 |
11.95 |
| Telephone Call with WIC Clinic |
G4 |
9 |
9 |
1 |
9 |
1.00 |
9.00 |
0 |
1 |
0 |
0.02 |
0.00 |
9.00 |
14.91 |
134.19 |
| Informed Consent for Site Director Interview |
G5 |
9 |
9 |
1 |
9 |
0.08 |
0.75 |
0 |
1 |
0 |
0.02 |
0.00 |
0.75 |
14.91 |
11.20 |
| Site Director Interview Guide |
C6 |
9 |
9 |
1 |
9 |
0.75 |
6.75 |
0 |
1 |
0 |
0.02 |
0.00 |
6.75 |
14.91 |
100.64 |
| Finalize Plans with WIC Clinic on Day of Site Visit |
n/a |
9 |
9 |
1 |
9 |
0.25 |
2.25 |
0 |
1 |
0 |
0.02 |
0.00 |
2.25 |
14.91 |
33.55 |
| Informed Consent for Observation and Staff Interview |
G6 |
9 |
9 |
6 |
54 |
0.08 |
4.51 |
0 |
6 |
0 |
0.02 |
0.00 |
4.51 |
14.91 |
67.23 |
| Identified Risks Data Collection Form |
C7a |
9 |
9 |
5 |
45 |
0.08 |
3.76 |
0 |
5 |
0 |
0.02 |
0.00 |
3.76 |
14.91 |
56.02 |
| Staff Interview Guide |
C8 |
9 |
9 |
5 |
45 |
1.00 |
45.00 |
0 |
5 |
0 |
0.02 |
0.00 |
45.00 |
14.91 |
670.95 |
| SUBTOTAL OF WIC CLINIC |
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14 |
10 |
20.20 |
202 |
0.38 |
76.85 |
4 |
1.00 |
4 |
0.07 |
0.28 |
77.13 |
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1150.01 |
| TOTAL PROFIT/NON-PROFIT BUSINESS |
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130 |
101 |
5.55 |
561 |
0.29 |
161.65 |
29 |
5.41 |
157 |
0.02 |
3.09 |
164.74 |
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6308.24 |
| Individuals and Households |
WIC Participants |
PRETEST |
n/a |
4 |
2 |
1 |
2 |
0.96 |
1.92 |
2 |
1 |
2 |
0.12 |
0.24 |
2.16 |
7.25 |
15.66 |
| Study Brochure for WIC Participant |
G7, G7a |
1020 |
510 |
1 |
510 |
0.05 |
25.55 |
510 |
1 |
510 |
0.02 |
8.52 |
34.07 |
7.25 |
246.99 |
| WIC Participant Screener |
G8, G8a |
1020 |
510 |
1 |
510 |
0.02 |
8.52 |
510 |
1 |
510 |
0.02 |
8.52 |
17.03 |
7.25 |
123.50 |
| Informed Consent for Observation and WIC Participant Interview |
G9, G9a |
510 |
510 |
1 |
510 |
0.08 |
42.59 |
0 |
1 |
0 |
0.02 |
0.00 |
42.59 |
7.25 |
308.74 |
| Nutrition Services Observation Form |
C7 |
510 |
510 |
1 |
510 |
0.02 |
8.52 |
0 |
1 |
0 |
0.02 |
0.00 |
8.52 |
7.25 |
61.75 |
| WIC Participant Interview Guide (In-Person) |
C9, C9a |
510 |
153 |
1 |
153 |
0.50 |
76.50 |
357 |
1 |
357 |
0.02 |
5.96 |
82.46 |
7.25 |
597.85 |
| WIC Participant Interview Guide (Phone) |
C9, C9a |
255 |
147 |
1 |
147 |
0.50 |
73.50 |
108 |
1 |
108 |
0.02 |
1.80 |
75.30 |
7.25 |
545.95 |
| Reminder Text for WIC Participant Interview to be Conducted Over the Phone |
G10, G10a |
255 |
102 |
1 |
102 |
0.02 |
1.70 |
153 |
1 |
153 |
0.02 |
2.56 |
4.26 |
7.25 |
30.87 |
| Reminder Call for WIC Participant Interview to be Conducted Over the Phone |
G11, G11a |
153 |
45 |
1 |
45 |
0.02 |
0.75 |
108 |
1 |
108 |
0.02 |
1.80 |
2.56 |
7.25 |
18.52 |
| TOTAL OF WIC PARTICIPANTS |
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1024 |
512 |
4.86 |
2489 |
0.10 |
239.54 |
512 |
3.41 |
1748 |
0.02 |
29.40 |
268.94 |
|
1949.84 |
| TOTAL REPORTING BURDEN |
|
1454 |
865 |
5.16 |
4462 |
0.19 |
832.55 |
589 |
3.73 |
2197 |
0.02 |
37.36 |
869.91 |
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26201.32 |
| Additional 33% to Account for Fully Loaded Wage Rate |
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8646.43 |
| TOTAL REPORTING BURDEN (FULLY LOADED) |
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34847.75 |