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Information Collection

Assessing programmatic efforts and technical assistance needs of WISEWOMAN

IC 196993 under ICR 201008-0920-003 · OMB 0920-0864.

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Form
Form
Form
IC Document
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Information Collection (IC) Details

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Assessing programmatic efforts and technical assistance needs of WISEWOMAN
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Year 3 Evaluation Survey Part I IC_3_Survey Part I.doc Yes Yes Fillable Fileable
Form none Year 3 Evaluation Survey Part II IC_3_Survey Part II.doc Yes Yes Fillable Fileable
Form none Year 3 Evaluation Survey Part III IC_3_Survey Part III.doc Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

21 0
   
State, Local, and Tribal Governments
 
   100 %

  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 63 0 0 0 0 0
Annual IC Time Burden (Hours) 31 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 1: Web Survey Screen Shots (examples) Att 1_IC_3_Screenshot.pdf 03/17/2011
Supporting Statement IC_3_Supporting Statement 03 03 2011.docx 03/17/2011
Att 2: Intro email Att 2_IC_3_ Introductory Email.doc 03/17/2011
Att 3: Invitation email Att 3_IC_3_ Invitational Email.doc 03/17/2011
Att 4: Reminder email Att 4_IC_3_ Followup Email.doc 03/17/2011
Att 5: Thank you email Att 5_IC_3_Thank you Email.doc 03/17/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.