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Federal forms, ICRs, and supporting documents

Information Collection

Transgender Women > 18 years old - Eligibility Screener

IC 234906 under ICR 202301-0920-002 · OMB 0920-1262.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Transgender Women > 18 years old - Eligibility Screener
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Eligibility Screener (English) Att 4a_Eligibility Screener (English).docx Yes Yes Fillable Fileable
Form and Instruction None Eligibility Screener (Spanish) Att 5a_Eligibility Screener (Spanish).docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems  76 FR 4458

1,540 0
   
Individuals or Households
 
   100 %

  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 1,540 0 0 0 0 1,540
Annual IC Time Burden (Hours) 128 0 0 0 0 128
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.