Lifetime of Good Health Survey

Evaluation of Office on Women's Health Publications

Documents and Forms

Document Name Document Type
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

Information Collection (IC) Details

IC Title:	Lifetime of Good Health Survey	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:

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 %

	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

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.