Information Collection

Screening for the Women's Health Survey

IC 214583 under ICR 201501-0920-012 · OMB 0920-1065.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 3 Women's Health Survey (Screening).pdf	Other-WORD
Att 3 Women's Health Survey (Screening).pdf	Other-WORD

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-WORD			Att 3 Women's Health Survey (Screening).pdf		Yes	Yes	Fillable Printable
Other-WORD			Att 3 Women's Health Survey (Screening).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 606

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 Agency Discretion
Annual Number of Responses for this IC	606	606
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.