Information Collection

Female/screening instrument

IC 7467 under ICR 200803-0925-006 · OMB 0925-0543.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1b Female/screening instrument	Form and Instruction
1b Survey Attachment 1.b. Screening Instrument_Female Verison.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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
Form and Instruction	1b	Survey	Attachment 1.b. Screening Instrument_Female Verison.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	500	-500	1,000
Annual IC Time Burden (Hours)	85	-15,295	15,380
Annual IC Cost Burden (Dollars)	0	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.