OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Women's Health Survey

IC 214584 under ICR 201501-0920-012 · OMB 0920-1065.

Documents and Forms
Document Name
Document Type
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Other-WORD
IC Document
IC Document
IC Document
IC Document
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Information Collection (IC) Details

View Information Collection (IC)

Women's Health Survey
 
No New
 
Required to Obtain or Retain Benefits
 

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 (Complete).pdf Yes Yes Fillable Printable
Other-WORD Att 4_Invite and Info Sheet_rev_01-05-15_05-14-15.docx No   Paper Only

Health Consumer Health and Safety

 

2,424 0
   
Individuals or Households
 
   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 2,424 0 2,424 0 0 0
Annual IC Time Burden (Hours) 808 0 808 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 1a_ Authorizing Legislation Att 1a. Johannas Law.pdf 01/12/2015
Att 1b_Authorizing Legislation Att 1b. PHSA.DOC 01/12/2015
Att 2a_ 60d Published FRN Att 2a. 60-day FRN 2 26 2014.pdf 01/12/2015
Att 2b_Summary of Public Comments Att 2b. Summary of Public Comments.doc 01/12/2015
Att 5_IRB Approval Letter Att 5_IRB Approval Letter.pdf 01/12/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.