Information Collection

Office on Women's Health Mental Health Models Program Stakeholder Engagement with Subject Matter Experts

IC 235189 under ICR 201703-0990-003 · OMB 0990-0459.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0459 can be found here:

Documents and Forms

Document Name Document Type
0990-0459_ Women_girls mental health disparities NORC Stakeholder Protocol.doc Instruction
0990-0459_Women girls mental NORC MEMO_FastTrack Generic Clearance Submission.docx Request for approval: Fast Track Generic Clearance IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Office on Women's Health Mental Health Models Program Stakeholder Engagement with Subject Matter Experts	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			0990-0459_ Women_girls mental health disparities NORC Stakeholder Protocol.doc		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for approval: Fast Track Generic Clearance	0990-0459_Women girls mental NORC MEMO_FastTrack Generic Clearance Submission.docx	03/08/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.