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Clinic Visit Record For Family Planning Services
CLINIC VISIT RECORD FOR FAMILY PLANNING SERVICES
OMB: 0937-0005
IC ID: 165981
OMB.report
HHS/OASH
OMB 0937-0005
ICR 197910-0937-004
IC 165981
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CLINIC VISIT RECORD FOR FAMILY PLANNING SERVICES
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
PHS 6138-1
No
No
Form
THRU 14
No
No
Form
PHS6138-1
No
No
Form
PHS6138-14
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,800
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
320,000
0
0
0
0
320,000
Annual IC Time Burden (Hours)
48,000
0
0
0
0
48,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.