| Appendix B WIC NATS In-Person Data Collection 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 Clinic |
Site Visit Email to WIC Clinic and Schedule Call |
D1 |
21 |
21 |
1 |
21 |
0.08 |
1.75 |
0 |
1 |
0 |
0.02 |
0.00 |
1.75 |
14.40 |
25.25 |
| Telephone Call with WIC Clinic |
D2 |
21 |
21 |
1 |
21 |
1.00 |
21.00 |
0 |
1 |
0 |
0.02 |
0.00 |
21.00 |
14.40 |
302.40 |
| Informed Consent for Site Director Interview |
D3 |
21 |
21 |
1 |
21 |
0.08 |
1.75 |
0 |
1 |
0 |
0.02 |
0.00 |
1.75 |
14.40 |
25.25 |
| Site Director Interview Guide |
C1 |
21 |
21 |
1 |
21 |
0.75 |
15.75 |
0 |
1 |
0 |
0.02 |
0.00 |
15.75 |
14.40 |
226.80 |
| 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 |
14.40 |
75.60 |
| Informed Consent for Observation and Staff Interview |
D4 |
21 |
21 |
6 |
126 |
0.08 |
10.52 |
0 |
6 |
0 |
0.02 |
0.00 |
10.52 |
14.40 |
151.50 |
| Identified Risks Data Collection Form |
C2a |
21 |
21 |
5 |
105 |
0.08 |
8.77 |
0 |
5 |
0 |
0.02 |
0.00 |
8.77 |
14.40 |
126.25 |
| Staff Interview Guide |
C3 |
21 |
21 |
5 |
105 |
1.00 |
105.00 |
0 |
5 |
0 |
0.02 |
0.00 |
105.00 |
14.40 |
1512.00 |
| TOTAL STATE, LOCAL, TRIBAL GOVT |
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21 |
21 |
21.00 |
441 |
0.39 |
169.80 |
0 |
0.00 |
0 |
0.00 |
0.00 |
169.80 |
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2445.06 |
| Business or Other For-Profit and Nonprofit Institutions |
WIC Clinic |
Site Visit Email to WIC Clinic and Schedule Call |
D1 |
9 |
9 |
1 |
9 |
0.08 |
0.75 |
0 |
1 |
0 |
0.02 |
0.00 |
0.75 |
14.40 |
10.82 |
| Telephone Call with WIC Clinic |
D2 |
9 |
9 |
1 |
9 |
1.00 |
9.00 |
0 |
1 |
0 |
0.02 |
0.00 |
9.00 |
14.40 |
129.60 |
| Informed Consent for Site Director Interview |
D3 |
9 |
9 |
1 |
9 |
0.08 |
0.75 |
0 |
1 |
0 |
0.02 |
0.00 |
0.75 |
14.40 |
10.82 |
| Site Director Interview Guide |
C1 |
9 |
9 |
1 |
9 |
0.75 |
6.75 |
0 |
1 |
0 |
0.02 |
0.00 |
6.75 |
14.40 |
97.20 |
| 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 |
14.40 |
32.40 |
| Informed Consent for Observation and Staff Interview |
D4 |
9 |
9 |
6 |
54 |
0.08 |
4.51 |
0 |
6 |
0 |
0.02 |
0.00 |
4.51 |
14.40 |
64.93 |
| Identified Risks Data Collection Form |
C2a |
9 |
9 |
5 |
45 |
0.08 |
3.76 |
0 |
5 |
0 |
0.02 |
0.00 |
3.76 |
14.40 |
54.11 |
| Staff Interview Guide |
C3 |
9 |
9 |
5 |
45 |
1.00 |
45.00 |
0 |
5 |
0 |
0.02 |
0.00 |
45.00 |
14.40 |
648.00 |
| TOTAL PROFIT/NON-PROFIT BUSINESS |
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9 |
9 |
21.00 |
189 |
0.39 |
72.77 |
0 |
0.00 |
0 |
0.00 |
0.00 |
72.77 |
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1047.88 |
| Individuals and Households |
WIC Participants |
Study Brochure for WIC Participant |
D5, D5a |
1020 |
510 |
1 |
510 |
0.05 |
25.55 |
510 |
1 |
510 |
0.02 |
8.52 |
34.07 |
7.25 |
246.99 |
| WIC Participant Screener |
D6, D6a |
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 |
D7, D7a |
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 |
C2 |
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) |
C4, C4a |
510 |
150 |
1 |
150 |
0.50 |
75.00 |
360 |
1 |
360 |
0.02 |
6.01 |
81.01 |
7.25 |
587.34 |
| WIC Participant Interview Guide (Phone) |
C4, C4a |
255 |
150 |
1 |
150 |
0.50 |
75.00 |
105 |
1 |
105 |
0.02 |
1.75 |
76.75 |
7.25 |
556.46 |
| Reminder Text for WIC Participant Interview to be Conducted Over the Phone |
D8, D8a |
255 |
100 |
1 |
100 |
0.02 |
1.67 |
155 |
1 |
155 |
0.02 |
2.59 |
4.26 |
7.25 |
30.87 |
| Reminder Call for WIC Participant Interview to be Conducted Over the Phone |
D9, D9a |
155 |
50 |
1 |
50 |
0.02 |
1.00 |
105 |
1 |
105 |
0.02 |
1.75 |
2.75 |
7.25 |
19.96 |
| TOTAL OF WIC PARTICIPANTS |
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1020 |
510 |
4.88 |
2490 |
0.10 |
237.84 |
510 |
3.42 |
1745 |
0.02 |
29.14 |
266.98 |
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1935.62 |
| TOTAL REPORTING BURDEN |
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1050 |
540 |
5.78 |
3120 |
0.15 |
480.41 |
510 |
3.42 |
1745 |
0.02 |
29.14 |
509.55 |
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5428.55 |
| Additional 33% to Account for Fully Loaded Wage Rate |
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1791.42 |
| TOTAL REPORTING BURDEN (FULLY LOADED) |
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7219.97 |