Information Collection

Women's Health USA and Child Health USA User Satisfaction Surveys

IC 191193 under ICR 200904-0915-002 · OMB 0915-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 001_CHUSA Women's Health USA and Child Health USA User Satisfaction Surveys	Form and Instruction
001_CHUSA 001_CHUSA CHUSA 2008-2009 User Survey 080409.pdf	Form and Instruction
001_WHUSA 001_WHUSA WHUSA 2009 User Survey 080409.pdf	Form and Instruction
Women's Health USA 2008.pdf Women's Health USA Data Book	IC Document
Child Health USA 2007.pdf Child Health USA	IC Document
WHUSA and CHUSA_OMB_Generic_ss.pdf Supporting Statement	IC Document

IC Title:

Women's Health USA and Child Health USA User Satisfaction Surveys

Agency IC Tracking Number:

IC Status: New

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	001_CHUSA	001_CHUSA	CHUSA 2008-2009 User Survey 080409.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	001_WHUSA	001_WHUSA	WHUSA 2009 User Survey 080409.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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 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	2,000	0	0	0	0	0
Annual IC Time Burden (Hours)	320	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Women's Health USA Data Book	Women's Health USA 2008.pdf	10/30/2009
Child Health USA	Child Health USA 2007.pdf	10/30/2009
Supporting Statement	WHUSA and CHUSA_OMB_Generic_ss.pdf	10/30/2009

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