Information Collection

OWH Health Professional Women's Health Survey

IC 235790 under ICR 201803-0990-002 · OMB 0990-0281.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0281 can be found here:

Documents and Forms

Document Name Document Type
Form 1 OWH Health Professional Women's Health Survey Form
1 OWH Health Professional Womens Health Survey Instrument OWH Health Professional Womens Health Survey Instrument 2-19-19_OMB_updated.docx Form
OWH Health Professional Womens Health Survevy Supporting Statement A 4-2-19_OMB_updated.docx OWH Health Professional Survey Supplemental A IC Document
OWH Health Professional Womens Health Survey Supporting Statement B 4-2-19.docx OWH Health Professional Survey Supplemental A IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	OWH Health Professional Women's Health Survey	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
Form	1	OWH Health Professional Womens Health Survey Instrument	OWH Health Professional Womens Health Survey Instrument 2-19-19_OMB_updated.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	183	183
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OWH Health Professional Survey Supplemental A	OWH Health Professional Womens Health Survevy Supporting Statement A 4-2-19_OMB_updated.docx	05/07/2019
OWH Health Professional Survey Supplemental A	OWH Health Professional Womens Health Survey Supporting Statement B 4-2-19.docx	04/19/2019

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