OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Women's Health Needs STUDY_SCREENER

IC 234870 under ICR 202009-0920-017 · OMB 0920-1264.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Att F2 WHNS Informed Consent Form (Somali translations)_REVISED.docx Other-WORD Somali translations
Att F4 WHNS Informed Consent Form (Arabic Translations)_REVISED.docx Other-WORD Arabic translations
Att F5 WHNS Informed Consent Form (Amharic Translations)_REVISED.docx Other-WORD Armharic translations
Att G2 WHNS_Eligibility Screener (Somali translations)_REVISED.docx Other-WORD Somali translations
Att G4 WHNS_Eligibility Screener (Arabic translations)_REVISED.docx Other-WORD Arabic translations
Att G5 WHNS_Eligibility Screener (Amharic translations)_REVISED.docx Other-WORD Armharic translation
Att F3 WHNS Informed Consent Form (French Translations)_NEW.docx Other-WORD: French translation
Att F6 WHNS Informed Consent Form (Tigrinya Translations)_NEW.docx Other-WORD: Tigrinya Translation
Att G3 WHNS_Eligibility Screener (French translations)_NEW.docx Other-WORD: French Translation
Att G6 WHNS_Eligibility Screener (Tigrinya translations)_NEW.docx Other-WORD: Tigrinya Translation
Att G7 Womens Health Needs Study Eligibility Screener (Oromo translations)_NEW.docx Other-WORD: Oromo translations
Att F7 Womens Health Needs Informed Consent Form (Oromo Translations)_NEW.docx.docx Other-WORD - Oromo translation
Consent -English
Att F1 Womens Health Needs Informed Consent Form (English)_Clean.docx 		Form
Eligibility Screener
Att G1 Womens Health Needs Study Eligibility Screener (English)_Clean.docx 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Somali translations Att F2 WHNS Informed Consent Form (Somali translations)_REVISED.docx No   Paper Only
Other-WORD Arabic translations Att F4 WHNS Informed Consent Form (Arabic Translations)_REVISED.docx No   Paper Only
Other-WORD Armharic translations Att F5 WHNS Informed Consent Form (Amharic Translations)_REVISED.docx No   Paper Only
Other-WORD Somali translations Att G2 WHNS_Eligibility Screener (Somali translations)_REVISED.docx No   Paper Only
Other-WORD Arabic translations Att G4 WHNS_Eligibility Screener (Arabic translations)_REVISED.docx No   Paper Only
Other-WORD Armharic translation Att G5 WHNS_Eligibility Screener (Amharic translations)_REVISED.docx No   Paper Only
Other-WORD: French translation Att F3 WHNS Informed Consent Form (French Translations)_NEW.docx No   Paper Only
Other-WORD: Tigrinya Translation Att F6 WHNS Informed Consent Form (Tigrinya Translations)_NEW.docx No   Paper Only
Other-WORD: French Translation Att G3 WHNS_Eligibility Screener (French translations)_NEW.docx No   Paper Only
Other-WORD: Tigrinya Translation Att G6 WHNS_Eligibility Screener (Tigrinya translations)_NEW.docx No   Paper Only
Other-WORD: Oromo translations Att G7 Womens Health Needs Study Eligibility Screener (Oromo translations)_NEW.docx No   Paper Only
Form none Consent -English Att F1 Womens Health Needs Informed Consent Form (English)_Clean.docx No   Paper Only
Other-WORD - Oromo translation Att F7 Womens Health Needs Informed Consent Form (Oromo Translations)_NEW.docx.docx No   Paper Only
Form and Instruction none Eligibility Screener Att G1 Womens Health Needs Study Eligibility Screener (English)_Clean.docx No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 3,744 0 0 0 0 3,744
Annual IC Time Burden (Hours) 104 0 0 0 0 104
Annual IC Cost Burden (Dollars) 0 0 0 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.