Information Collection

Women's Health Needs STUDY_QUESTIONNAIRE

IC 234873 under ICR 201812-0920-006 · OMB 0920-1264.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att H1 Initial Pilot Questionnaire WHNS_ENGLISH_08092018.docx	Other-WORD English translations
Att H2 Initial Pilot Questionnaire WHNS_Somali.docx	Other-WORD Somali translations
Att H3 Initial Pilot Questionnaire WHNS_Swahili.docx	Other-WORD Swahili translations
Att H4 Initial Pilot Questionnaire WHNS_Arabic.docx	Other-WORD Arabic translations
Att H5 Initial Pilot Questionnaire WHNS_Armharic.docx	Other-WORD Armharic translations

IC Title:

Women's Health Needs STUDY_QUESTIONNAIRE

Agency IC Tracking Number:

0920-18JC

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD English translations	Att H1 Initial Pilot Questionnaire WHNS_ENGLISH_08092018.docx	No	Fillable Fileable
Other-WORD Somali translations	Att H2 Initial Pilot Questionnaire WHNS_Somali.docx	No	Paper Only
Other-WORD Swahili translations	Att H3 Initial Pilot Questionnaire WHNS_Swahili.docx	No	Paper Only
Other-WORD Arabic translations	Att H4 Initial Pilot Questionnaire WHNS_Arabic.docx	No	Paper Only
Other-WORD Armharic translations	Att H5 Initial Pilot Questionnaire 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: 400

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	400	400
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.