Main Instrument- General Population, Adult Women, 25+

Evaluation of the Consumer Education Campaign "Make the Call-Don't Miss a Beat"

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Main Instrument- General Population, Adult Women, 25+	Agency IC Tracking Number:

Is this a Common Form? No		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
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 %

	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

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.