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Women's Health Needs STUDY_QUESTIONNAIRE
Women’s Health Needs Study: The Health of US-Resident Women from Countries with Prevalent Female Genital Mutilation/Cutting (FGM/C)
OMB: 0920-1264
IC ID: 234873
OMB.report
HHS/CDC
OMB 0920-1264
ICR 202001-0920-016
IC 234873
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1264 can be found here:
2020-09-22 - No material or nonsubstantive change to a currently approved collection
2020-06-11 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Women's Health Needs STUDY_QUESTIONNAIRE
Agency IC Tracking Number:
0920-18JC
Is this a Common Form?
No
IC Status:
Unchanged
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
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
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
400
0
0
0
0
400
Annual IC Time Burden (Hours)
300
0
0
0
0
300
Annual IC Cost Burden (Dollars)
0
0
0
0
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.