Women's Health Survey

A Comprehensive Evaluation of a Paid Social Media and Mass Media Gynecologic Cancer Campaign

Documents and Forms

Document Name Document Type
Att 3 Women's Health Survey (Complete).pdf Other-WORD
Att 4_Invite and Info Sheet_rev_01-05-15_05-14-15.docx Other-WORD
Att 1a. Johannas Law.pdf Att 1a_ Authorizing Legislation IC Document
Att 1b. PHSA.DOC Att 1b_Authorizing Legislation IC Document
Att 2a. 60-day FRN 2 26 2014.pdf Att 2a_ 60d Published FRN IC Document
Att 2b. Summary of Public Comments.doc Att 2b_Summary of Public Comments IC Document
Att 5_IRB Approval Letter.pdf Att 5_IRB Approval Letter IC Document

Information Collection (IC) Details

IC Title:	Women's Health Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection 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 (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

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,424	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,424	2,424
Annual IC Time Burden (Hours)	808	808
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.