Information Collection

Lifetime of Good Health Survey

IC 181301 under ICR 200707-0990-002 · OMB 0990-0319.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Good Health Survey Lifetime of Good Health Survey	Form
EvaluationofWomensHealthLifetime of Good Health Survey - OWH Publications 7.12.07.doc	Other-survey
1 Good Health Survey Lifetime of Good Health Survey - OWH Publications 102307 (2).doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 241.301

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey			EvaluationofWomensHealthLifetime of Good Health Survey - OWH Publications 7.12.07.doc		No	No	Fillable Printable
Form	1	Good Health Survey	Lifetime of Good Health Survey - OWH Publications 102307 (2).doc		No		Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,163

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,163	1,163
Annual IC Time Burden (Hours)	291	291
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.