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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.