Ohio Health/T.O.P.P.

Evaluation of Pregnancy Prevention Approaches - First Follow-up

Documents and Forms

Document Name Document Type
0990-0382Attachment B_OHIO.pdf Other-survey
2_OhioHealth PPA FU _response to OMB_051412.docx Other-Survey
Instrument 4_OhioHealth FollowUp Survey.pdf Other-survey

Information Collection (IC) Details

IC Title:	Ohio Health/T.O.P.P.	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey	0990-0382Attachment B_OHIO.pdf	Yes	Yes	Printable Only
Other-Survey	2_OhioHealth PPA FU _response to OMB_051412.docx	Yes	Yes	Printable Only
Other-survey	Instrument 4_OhioHealth FollowUp Survey.pdf	No		Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 148	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	Previously Approved
Annual Number of Responses for this IC	444	-66	510
Annual IC Time Burden (Hours)	311	-46	357
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.