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Bright Futures for Women's Health and Wellness - Consumer Survey
Bright Futures for Women's Health and Wellness
OMB: 0915-0329
IC ID: 190116
OMB.report
HHS/HSA
OMB 0915-0329
ICR 200907-0915-003
IC 190116
( )
Documents and Forms
Document Name
Document Type
Form 001_BFWHWEmWellCon
Bright Futures for Women's Health and Wellness - Consumer Survey
Form
001_BFWHWEmWellCon 001_BFWHWEmWellCon
BFWHW Consumer Survey Tool.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Bright Futures for Women's Health and Wellness - Consumer Survey
Agency IC Tracking Number:
Is this a Common Form?
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
001_BFWHWEmWellCon
001_BFWHWEmWellCon
BFWHW Consumer Survey Tool.pdf
Yes
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
563
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
563
0
563
0
0
0
Annual IC Time Burden (Hours)
141
0
141
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
