Screening and Assessment MDE and Lifestyle Program MDE

Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Reporting System

OMB: 0920-0612

IC ID: 37802

Information Collection (IC) Details

View Information Collection (IC)

Screening and Assessment MDE and Lifestyle Program MDE
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Attachment 3 WISEWOMAN MDE Version 9 0.pdf Yes Yes Fillable Fileable
Form and Instruction none WISEWOMAN data management system portal Attachment 4 Data Submission Portal.pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

21 0
   
State, Local, and Tribal Governments
 
   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 42 0 0 0 0 42
Annual IC Time Burden (Hours) 1,008 0 0 0 0 1,008
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 4 Screen Shots of Portal Attachment 4 Screen Shots of Portal 09 24 2013.pdf 10/29/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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