OMB Number: 0584-0524 Expiration
		Date: 2/28/2026 
	
Dear WIC State Agency Director,
Westat would like to ensure we have the most updated contact information for each State agency. Please complete the information below and return this form by January 16, 2024. Email to WICPC2024@westat.com.
State Agency:
WIC Director:
Name:
Title/Position:
Phone:
Email:
Alternate contact, if not the Director: Another person who can provide information if the Director is not available.
Name:
Title/Position:
Phone:
Email:
Do you want this person copied on all communications?
Yes No
Information technology contact for PC 2024: Responsible for technical communications regarding PC 2024. We will contact this person on technical issues regarding submissions.
Name:
Title/Position:
Phone:
Email:
Indicate if:
State agency employee
Contractor or consultant. If contractor, specify company:
Should the main contact be copied on all technical communications?
Yes No
Nutritionist contact for PC 2024: Responsible for Nutritional Risk and Food Package Coding information.
Is the person the same as alternate contact? Yes No
(if
no, please complete fields below)
Name:
Title/Position:
Phone:
 
	This
	information is being collected from State agencies to enable the
	Food and Nutrition Service (FNS) to prepare biennial reports on WIC
	participant and program characteristics. This is a mandatory
	collection authorized under 7 CFR §246.25(b)(3).  FNS uses
	the data from these reports to estimate budgets, submit civil rights
	reporting, identify needs for research, and to develop and review
	WIC policies and procedures.  Under the Privacy Act of 1974 and
	the System of Record Notice FNS-8 USDA/FNS Studies and Reports, any
	personally identifying information obtained will be kept private to
	the extent of the law.  According to the Paperwork Reduction
	Act of 1995, an agency may not conduct or sponsor, and a person is
	not required to respond to, a collection of information unless it
	displays a valid OMB control number. The valid OMB control number
	for this information collection is 0584-0524. The time required to
	complete this information collection is estimated to average 12
	minutes per response, including the time for reviewing instructions,
	searching existing data sources, gathering and maintaining the data
	needed, and completing and reviewing the collection of information.
	Send comments regarding this burden estimate or any other aspect of
	this collection of information, including suggestions for reducing
	this burden, to: U.S. Department of Agriculture, Food and Nutrition
	Services, Office of Policy Support, 1320 Braddock Place, Alexandria,
	VA 22314, ATTN: PRA (0584-0524*). Do not return the completed form
	to this address. 
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | Kim Kerson | 
| File Modified | 0000-00-00 | 
| File Created | 2023-12-12 |