Information Collection

Annual Progress Report

IC 191867 under ICR 202502-0920-014 · OMB 0920-0612.

Documents and Forms

Document Name Document Type
Annual Progress Report Form and Instruction
WISEWOMAN Annual Progress Report Att 5 Annual Progress Report.pdf Form and Instruction
WISEWOMAN Annual Progress Report Att 5 Annual Progress Report.pdf Form and Instruction
0920-0621 WISEWOMAN-MDE_Annual Progress Report Attachment 6 Annual Progress Report.pdf Form and Instruction
0920-0621 WISEWOMAN-MDE_Annual Progress Report Attachment 6 Annual Progress Report.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Progress Report	Agency IC Tracking Number:	0920-0612-23HT

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	None	WISEWOMAN Annual Progress Report	Att 5 Annual Progress Report.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0621	WISEWOMAN-MDE_Annual Progress Report	Attachment 6 Annual Progress Report.pdf	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	640	640
Annual IC Cost Burden (Dollars)	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.