Appendix U Burden Table

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Overview

Age 5 Extension Burden Table
Sheet1

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Sheet 1: Age 5 Extension Burden Table

Appendix U Burden Table
Respondent Type	Respondent Description	Type of Survey Instrument			Appendices	Sample size (a)	Number of Respondents (o)	Frequency of Response (annual)	Total Annual Responses	Average Hours per Response	Sub- Annual Burden	Number of non -respondents (o)	Frequency of Response (annual)	Total Annual Responses	Average Hours per response	Sub-Total Annual Burden	Total Burden Hours	Hourly Rate	Total Annualized Cost
Individuals and Households	WIC Participants	Study extension flyer (b)			A	4,046	3,277	1	3,277	0.0250	81.93	769	1	769	0.0250	19.22	101.15	$7.25	$733.34
		Study extension consent form age 2.5 to 5 (b)			B	4,046	3,277	1	3,277	0.0333	109.13	769	1	769	0.0333	25.60	134.73	$7.25	$976.81
		36-mo survey: contact information module (c)			C	4,046	2,444	1	2,444	0.0833	203.57	1,602	1	1,602	0.0833	133.46	337.03	$7.25	$2,443.48
		39-mo contact information form (d)			D	2,950	2,065	1	2,065	0.1000	206.47	885	1	885	0.1000	88.49	294.95	$7.25	$2,138.41
		42-mo advance letter (e)			E	2,950	2,507	1	2,507	0.0333	83.49	442	1	442	0.0333	14.73	98.22	$7.25	$712.09
		42-mo telephone survey (c )			F	4,046	2,319	1	2,319	0.5000	1,159.38	1,727	1	1,727	0.0000	0.00	1,159.38	$7.25	$8,405.51
		Reminders 42-mo interview (f)			G1-G9	2,950	2,950	3	8,849	0.0208	184.05	0	3	0	0.0208	0.00	184.05	$7.25	$1,334.37
		Letter to study refusals (g)			G10	250	125	1	125	0.0500	6.25	125	1	125	0.0500	6.25	12.50	$7.25	$90.63
		42-mo thank you (h)			H1	2,319	1,855	1	1,855	0.0042	7.79	464	1	464	0.0042	1.95	9.74	$7.25	$70.61
		45-mo contact information form (d )			D	2,802	1,961	1	1,961	0.1000	196.14	841	1	841	0.1000	84.06	280.21	$7.25	$2,031.49
		48-mo advance letter (e)			I	2,802	2,382	1	2,382	0.0500	119.09	420	1	420	0.0500	21.02	140.10	$7.25	$1,015.75
		48-mo telephone survey (c)			J	4,046	2,200	1	2,200	0.5000	1,099.91	1,846	1	1,846	0.0000	0.00	1,099.91	$7.25	$7,974.31
		48-mo H/W measurement letter and card (i)			K, L	2,200	1,540	1	1540	1.0000	1,539.87	660	1	660	0.0000	0.00	1,539.87	$7.25	$11,164.04
		HIPAA form 48-mo measurement (j)			M	440	220	1	220	0.0500	11.00	220	1	220	0.0500	11.00	22.00	$7.25	$159.49
		48-mo Text or email provider measures (k)			N	440	110	1	110	0.0500	5.50	330	1	330	0.0000	0.00	5.50	$7.25	$39.87
		48-mo Home health agency measurement (l)			O	440	3	1	3	0.5000	1.50	437	1	437	0.5000	218.49	219.98	$7.25	$1,594.86
		Reminders 48-mo interview (f)			G1-G9	2,802	2,802	3	8,406	0.0208	174.85	0	3	0	0.0208	0.00	174.85	$7.25	$1,267.65
		Height and weight reminders (m)			G11	2,802	2,802	2	5,604	0.0083	46.51	0	2	0	0.0083	0.00	46.51	$7.25	$337.23
		48-mo thank you (h)			H2	2,200	1,760	1	1,760	0.0042	7.39	440	1	440	0.0042	1.85	9.24	$7.25	$66.98
		51-mo contact information form (d)			D	2,655	1,858	1	1,858	0.1000	185.82	796	1	796	0.1000	79.64	265.46	$7.25	$1,924.57
		54-mo advance letter (e)			P	2,655	2,256	1	2,256	0.0333	75.14	398	1	398	0.0333	13.26	88.40	$7.25	$640.88
		54-mo telephone survey (c)			Q	4,046	2,087	1	2,087	0.5000	1,043.46	1,959	1	1,959	0.0000	0.00	1,043.46	$7.25	$7,565.11
		Reminders 54-mo interview (f)			G1-G9	2,655	2,655	3	7,964	0.0208	165.65	0	3	0	0.0208	0.00	165.65	$7.25	$1,200.93
		54-mo thank you (h)			H3	1,760	1,408	1	1,408	0.0042	5.91	352	1	352	0.0042	1.48	7.39	$7.25	$53.59
		57-mo contact information form (d)			D	2,522	1,765	1	1,765	0.1000	176.53	757	1	757	0.1000	75.66	252.19	$7.25	$1,828.34
		60-mo advance letter (e)			R	2,522	2,144	1	2,144	0.0500	107.18	378	1	378	0.0500	18.91	126.09	$7.25	$914.17
		60-mo telephone survey (c)			S	4,046	1,980	1	1,980	0.5000	989.85	2,066	1	2,066	0.0000	0.00	989.85	$7.25	$7,176.44
		60- mo H/W measurement letter and card (i)			K, L	1,980	1,386	1	1386	1.0000	1,385.80	594	1	594	0.0000	0.00	1,385.80	$7.25	$10,047.02
		HIPAA form 60-mo measurement (j)			M	396	198	1	198	0.0500	9.90	198	1	198	0.0500	9.90	19.80	$7.25	$143.53
		60-mo text or mail provider measures (k)			N	396	99	1	99	0.0500	4.95	297	1	297	0.0000	0.00	4.95	$7.25	$35.88
		60-mo home health agency measurement (l)			O	396	3	1	3	0.5000	1.35	393	1	393	0.0000	0.00	1.35	$7.25	$9.76
		Reminders 60-mo interview (f)			G1-G9	2,522	2,522	3	7,566	0.0208	157.36	0	3	0	0.0208	0.00	157.36	$7.25	$1,140.89
		Height and weight reminders (m)			G11	2,522	2,522	2	5,044	0.0083	41.86	0	2	0	0.0083	0.00	41.86	$7.25	$303.50
		60-mo thank you (h)			H4	1,980	1,584	1	1,584	0.0042	6.65	396	1	396	0.0042	1.66	8.31	$7.25	$60.28
		Birthday card respondent year 4 (n)			T1	2,802	2,242	1	2,242	0.0083	18.61	560	1	560	0.0083	4.65	23.26	$7.25	$168.61
		Birthday card child age 4 (n)			T2	2,802	2,241	2	4,482	0.0083	37.20	561	2	1,122	0.0083	9.31	46.51	$7.25	$337.23
		Birthday card respondent year 5 (n)			T3	2,522	2,017	1	2,017	0.0083	16.75	504	1	504	0.0083	4.19	20.93	$7.25	$151.75
		Birthday card child age 5 (n)			T4	2,522	2,017	2	4,034	0.0083	33.48	504	2	1,009	0.0083	8.37	41.85	$7.25	$303.45
Individuals and Households Subtotal (o)						4,046	3,277		101,019		9,707.25	2,066		23,757		853.14	10,560.39		$76,562.85
State & Local Government	State WIC data manager or POC	Study extension webinar (p)			V	27	27	1	27	1.0000	27.00	0	1	0	1.0000	0.00	27.00	$54.08	$1,460.16
		Conference calls on extension (q)			W1	27	27	2	54	1.0000	54.00	0	2	0	1.0000	0.00	54.00	$54.08	$2,920.32
		Communication materials (r)			X1, X2, Y1, Y2	27	27	1	27	0.2667	7.20	0	1	0	0.2667	0.00	7.20	$54.08	$389.42
		HT/WT Admin data form (s)			Y3	27	27	2	54	1.5000	81.00	0	2	0	1.5000	0.00	81.00	$54.08	$4,380.48
		Subtotal				27	27	6	162		169.20	0	6	0		0.00	169.20		$9,150.38
	WIC site staff	Study extension webinar (p)			V	80	80	2	160	1.0000	160.00	0	2	0	1.0000	0.00	160.00	$54.08	$8,652.80
		Conference call on extension (q)			W2	80	80	2	160	1.0000	160.00	0	2	0	1.0000	0.00	160.00	$54.08	$8,652.80
		Communication materials (r)			X1, X2, Y1, Y2	80	80	1	80	0.2667	21.34	0	1	0	0.2667	0.00	21.34	$13.86	$295.72
		Request for contact information (t)			Z	80	80	33	2,640	0.0833	219.91	0	33	0	0.0833	0.00	219.91	$13.86	$3,047.98
		HT/WT measurement (u)			K	80	80	22	1,760	0.1667	293.39	0	22	0	0.1667	0.00	293.39	$13.86	$4,066.41
		Subtotal				80	80		4,800		854.64	0		0		0.00	854.64		$24,715.71
State/Local Government Subtotal						107	107		4,962		1,023.84	0		0		0.00	1,023.84		$33,866.10
Profit/Non-Profit Business	Provider data manager	Provider Data Request Form (v)			AA	418	334	1	334	0.0833	27.85	84	1	84	0.0833	6.96	34.82	$13.86	$482.54
Profit/Non-Profit Business Subtotal						418	334		334		27.85	84		84		6.96	34.82		$482.54
GRAND TOTAL						4,571	3,719		106,315		10,758.95	2,150		23,841		860.10	11,619.05		$110,911.49
(a) 4046 = base study total live birth cohort, out of 4367 enrolled initially.
(b) Assume study attrition from base enrolled of 10% per year (e.g., 4046*.9*.9* = 3,277) so 3,277 will get flyer and consent for extension.
(c) Of base study total live birth cohort -- assume about 60% will complete 36-month survey, 57% will complete 42-month survey, 54% will complete 48-month survey; 51% will complete 54-month survey, 49% will complete 60-month survey
(d Assume study attrition from base study enrolled of 10% per year (e.g., 4,046*.9*.9*.9 = 2,950 for year 3). Assume 70% will complete contact information form.
(e) Assume 85% will read the advance letter.
(f) Potential respondents for 42-, 48-, 54, and 60-mo interviews may get 1 or more of the 9 reminders in Appendix G1-G9. Total burden for these reminders = 11.25 minutes (G1=1 min, G2=1 min, G3=3 min, G4=3 min, G5=0.5 min, G6=0.5 min, G7=1 min, G8=0.25 min, G9=1 min.) and average length of time for these reminders is 1.25 minutes (11.25/9). Assume respondents will get an average of 3 reminders each.
(g) Assume 250 study refusals will be sent letter inviting them to re-enroll in the study and 50% will have a valid address to receive the letter.
(h) Assume 80% of respondents will have a valid email/text/mail address to receive thank you.
(i) Assume 70% of respondents to the 48-mo or 60-mo interview will go to the WIC site or their provider for H/W measurement. Assume 1 hour for reading letter, travel to/from WIC site or provider, and measuring child.
(j) Assume 20% of those who complete interview will not agree to go to WIC/provider but will agree to sign HIPAA form and 50% of these will return form.
(k) Assume 20% of those who complete the interview will not agree to go to WIC/provider but will agree to send in provider measures and 25% will do so.
(l) Assume 3 will use HHA for measurement.
(m) Assume potential respondents for 48-mo and 60-mo HT/WT measures will get an average of 2 reminders to go to WIC or their doctor's office to have their child measured.
(n) Assume 80% of cohort will read birthday cards. Mother and child will both read child card.
(o) Total respondents + nonrespondents is larger than sample size as some study participants may respond to some data collection activities and be non-respondents for others.
(p) Assume study extension webinar attended by all 27 states and 2 reps from each site.
(q) Assumes 1 conf. call with state and 1 conf. call with state and site with 2 representatives per site.
(r) Total time burden is 16 minutes to read correspondence about extension and includes W1 (3 min) or W2 (3 min), X1 (7 min) , X2 (3 min), along with a short phone call after the webinar and conference call to answer any questions (3 min).
(s) Assume administrative H/W records will be provided by State WIC office 2 times for those enrolled in WIC who do not return H/W card.
(t) Assume will request participant contact information from WIC sites about once a month over data collection period.
(u) Assume 60% of participants who return measurement cards will be measured at WIC with about 22 children weighed and measured per site (((1540+1386)*.60)/80=22). Assume 10 minutes of staff time for measurements per child.
(v) Assume H/W data for participants who returned HIPAA form will be provided by 80% of providers.

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Sheet 2: Sheet1

(a) 4046 = base study total live birth cohort

(b) Of base study total live birth cohort -- assume about 60% will complete 36-month survey, 57% will complete 42-month survey, 54% will complete 48-month survey; 51% will complete 54-month survey, 49% will complete 60-month survey

(c ) Assume study attrition from base study enrolled of 10% per year (e.g., 4,046*.9*.9*.9 = 2,950 for year 3). Assume 70% will complete contact information form.

(d) Assume 85% will read the advance letter.

(e) Potential respondents for 42-mo and 54-mo interviews may get 1 or more of the 9 reminders in Appendix E1-E9. Total burden for these reminders = 11.25 minutes (E1=1 min, E2=1 min, E3=3 min, E4=3 min,
E5=.5 min, E6=.5 min, E7=1 min, E8=.25 min, E9=1 min.) and average length of time for these reminders is 1.25 minutes (11.25/9). Assume respondents will get an average of 3 reminders each.

(f) Assume 250 study refusals will be sent letter inviting them to re-enroll in the study and 50% will have a valid address to receive the letter.

(g) Assume 80% of respondents will have a valid email/text/mail address to receive thank you.

(h) Assume 70% of respondents to the 48-mo or 60-mo interview will go to the WIC site or their provider for H/W measurement. Assume 1 hour for reading letter, travel to/from WIC site or provider, and measuring child.

(i) Assume 20% of those who complete interview will not agree to go to WIC/provider but will agree to sign HIPAA form and 50% of these will return form.

(j) Assume 20% of those who complete the interview will not agree to go to WIC/provider but will agree to send in provider measures and 25% will do so.

(k) Assume 3 will use HHA for measurement.

(l) Potential respondents for 48-mo and 60-mo interviews and HT/WT measures will get 1 or more of the 10 reminders in Appendix E1-E10. Total burden for these reminders = 11.75 minutes (E1=1 min, E2=1 min, E3=3 min, E4=3 min, E5=.5 min, E6=.5 min, E7=1 min, E8=.25 min, E9=1 min, E10=.5 min) and average length of time for these reminders is 1.1 minutes (11.25/10). Assume respondents will get an average of 5 reminders each.

(m) Assume 80% of cohort will read birthday cards. Mother and child will both read child card.

(n) Assume study extension webinar attended by all 27 states and 2 reps from each site.

(o) Assumes 1 conf. call with state and 1 conf. call with state and site with 2 representatives per site.

(p) Total time burden to is 13 minutes to read correspondence about extension and includes U1 (3 min) or U2 (3 min), V1 (7 min) and V2 (3 min).

(q) Assume administrative H/W records will be provided by State WIC office 2 times for those enrolled in WIC who do not return H/W card.

(r) Assume will request participant contact information from WIC sites about once a month over data collection period.

(s) Assume 60% of participants who return measurement cards will be measured at WIC with about 22 children weighed and measured per site (((1540+1386)*.60)/80=22). Assume 10 minutes for measurements per child.

(t) Assume H/W data for participants who returned HIPAA form will be provided by 80% of providers.