Information Collection

WISEWOMAN Programs

IC 183886 under ICR 200802-0920-011 · OMB 0920-0679.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0679 can be found here:

Documents and Forms

Document Name Document Type
CHB MIS Data Collection Tool.doc Other-WORD
Attachment 6. Proposed Revisions.doc Other-WORD
Attachment 5. Usability Results.doc Usability Testing Results IC Document
Attachment 4. Usability Test Participants.doc Usability and Pilot Tests Participants IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	WISEWOMAN Programs	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			CHB MIS Data Collection Tool.doc		No	No	Fillable Printable
Other-WORD			Attachment 6. Proposed Revisions.doc		No	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Usability Testing Results	Attachment 5. Usability Results.doc	01/16/2008
Usability and Pilot Tests Participants	Attachment 4. Usability Test Participants.doc	01/16/2008

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