Information Collection

Women's Health Needs STUDY_QUESTIONNAIRE

IC 234873 under ICR 202006-0920-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 H2 WHNS_Questionnaire (Somali Translations)_REVISED.docx	Other-WORD Somali translations
Att H4 WHNS_Questionnaire (Arabic Translations)_REVISED.docx	Other-WORD Arabic translations
Att H5 WHNS_Questionnaire (Amharic Translations)_REVISED.docx	Other-WORD Armharic translations
Att H3 WHNS_Questionnaire (French Translations)_NEW.docx	Other-WORD: French Translation
Att H6 WHNS_Questionnaire (Tigrinya Translations)_NEW.docx	Other-WORD: Tigrinya Translation
0920-1264 Women's Health Need Study (revised) Att H1 WHNS_Questionnaire (English)_Clean.docx	Form and Instruction

IC Title:

Women's Health Needs STUDY_QUESTIONNAIRE

Agency IC Tracking Number:

0920-20OZ

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Other-WORD Somali translations			Att H2 WHNS_Questionnaire (Somali Translations)_REVISED.docx	No	Paper Only
Other-WORD Arabic translations			Att H4 WHNS_Questionnaire (Arabic Translations)_REVISED.docx	No	Paper Only
Other-WORD Armharic translations			Att H5 WHNS_Questionnaire (Amharic Translations)_REVISED.docx	No	Paper Only
Other-WORD: French Translation			Att H3 WHNS_Questionnaire (French Translations)_NEW.docx	No	Paper Only
Other-WORD: Tigrinya Translation			Att H6 WHNS_Questionnaire (Tigrinya Translations)_NEW.docx	No	Paper Only
Form and Instruction	0920-1264	Women's Health Need Study (revised)	Att H1 WHNS_Questionnaire (English)_Clean.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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	Previously Approved
Annual Number of Responses for this IC	2,000	1,600	400
Annual IC Time Burden (Hours)	500	200	300
Annual IC Cost Burden (Dollars)	0	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.