Information Collection

Engender Health

IC 201760 under ICR 201502-0990-002 · OMB 0990-0382.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0382Attachment E_ENGENDER HEALTH.pdf	Other-instrument
Instrument 3_EngenderHealth FollowUp Survey.pdf	Other-survey

IC Title:

Engender Health

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-instrument			0990-0382Attachment E_ENGENDER HEALTH.pdf		Yes	Yes	Printable Only
Other-survey			Instrument 3_EngenderHealth FollowUp Survey.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 240

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	480	-158	638
Annual IC Time Burden (Hours)	288	-95	383
Annual IC Cost Burden (Dollars)	0	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.