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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.