Women's Health Needs STUDY_SCREENER

Women’s Health Needs Study: The Health of US-Resident Women from Countries with Prevalent Female Genital Mutilation/Cutting (FGM/C)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1264 can be found here:

Documents and Forms

Document Name Document Type
Att F1 Informed Consent_English.docx Other-WORD
Att F2 Informed Consent_Somali.docx Other-WORD Somali translations
Att F3 Informed Consent_Swahili.docx Other-WORD Swahili translations
Att F4 Informed Consent_Arabic.docx Other-WORD Arabic translations
Att F5 Informed Consent_Armharic.docx Other-WORD Armharic translations
Att G2 Initial Pilot Screener WHNS_Somali.docx Other-WORD Somali translations
Att G3 Initial Pilot Screener WHNS_Swahili.docx Other-WORD Swahili translations
Att G4 Initial Pilot Screener WHNS_Arabic.docx Other-WORD Arabic translations
Att G5 Initial Pilot Screener WHNS_Armharic.docx Other-WORD Armharic translation
0920-18JC Women's Health Need STUDY_Screener Att G1 Initial Pilot Screener WHNS _ENGLISH_09182018.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Women's Health Needs STUDY_SCREENER	Agency IC Tracking Number:	0920-18JC

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Other-WORD			Att F1 Informed Consent_English.docx	No	Paper Only
Other-WORD Somali translations			Att F2 Informed Consent_Somali.docx	No	Paper Only
Other-WORD Swahili translations			Att F3 Informed Consent_Swahili.docx	No	Paper Only
Other-WORD Arabic translations			Att F4 Informed Consent_Arabic.docx	No	Paper Only
Other-WORD Armharic translations			Att F5 Informed Consent_Armharic.docx	No	Paper Only
Form and Instruction	0920-18JC	Women's Health Need STUDY_Screener	Att G1 Initial Pilot Screener WHNS _ENGLISH_09182018.docx	No	Fillable Fileable
Other-WORD Somali translations			Att G2 Initial Pilot Screener WHNS_Somali.docx	No	Paper Only
Other-WORD Swahili translations			Att G3 Initial Pilot Screener WHNS_Swahili.docx	No	Paper Only
Other-WORD Arabic translations			Att G4 Initial Pilot Screener WHNS_Arabic.docx	No	Paper Only
Other-WORD Armharic translation			Att G5 Initial Pilot Screener WHNS_Armharic.docx	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 667	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	667	667
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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