Annual Progress Report

Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Reporting System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0612 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0612 Annual Progress Report Form and Instruction
0920-0612 Annual Progress Report 0612 Att 5 Annual Progress Report Final.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Annual Progress Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0612	Annual Progress Report	0612 Att 5 Annual Progress Report Final.pdf		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35	11	24
Annual IC Time Burden (Hours)	560	176	384
Annual IC Cost Burden (Dollars)	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.