Information Collection

Main Instrument- General Population, Adult Women, 25+

IC 201889 under ICR 201204-0990-001 · OMB 0990-0393.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-Makethe call_Main Questionnaire_Appendix C OWH questions to be added to AHA survey 2 14 12.docx	Other-survey
0990-Makethecall_Appendix D Question testing summary 2 14 12.docx 0990-Makethecall_Appendix D Question testing summary 2 14 12	IC Document
0990-Appendix A AHA surey article Twelve-Year Follow-up Cardio Risk.pdf 0990-Appendix A AHA surey article Twelve-Year Follow-up Cardio Risk	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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
Other-survey			0990-Makethe call_Main Questionnaire_Appendix C OWH questions to be added to AHA survey 2 14 12.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0990-Makethecall_Appendix D Question testing summary 2 14 12	0990-Makethecall_Appendix D Question testing summary 2 14 12.docx	02/28/2012
0990-Appendix A AHA surey article Twelve-Year Follow-up Cardio Risk	0990-Appendix A AHA surey article Twelve-Year Follow-up Cardio Risk.pdf	04/10/2012

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