Women's Preventive Health Services Survey

OMB 0920-1200

The goal of this study is to assess use of clinical preventive services, facilitators and barriers to use of clinical preventive services, and the ability to maintain consistent health insurance coverage among newly insured women who previously received cancer screenings through the National Breast and Cervical Cancer Early Detection Program. Results will inform how public health programs can support low-income medically underserved women to ensure they receive appropriate preventive health care services.

The latest form for Women's Preventive Health Services Survey expires 2020-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Women's Preventive Health Services Survey Form
Revised WPHSS_Supp St_Part A_09 14 17.docx Supporting Statement A
Attachment 14. WPHSS_NORC IRB approval letter.pdf Supplementary Document
Attachment 13. WPHSS_Mid Year Thank You Letter.docx Supplementary Document
Attachment 12. WPHSS_Phone scripts for states to share contact information.docx Supplementary Document
Attachment 11. WPHSS_Letter from states to share contact information.docx Supplementary Document
Attachment 10. WPHSS_Final Letter_Bilingual.docx Supplementary Document
Attachment 9. WPHSS_Reminder Postcard Text_Bilingual.docx Supplementary Document
Attachment 4. WPHSS_Invitation Letter_Bilingual.docx Supplementary Document
Attachment 2. WPHSS_60dayFRN-DCPC-Miller.pdf Supplementary Document
Attachment 1. Breast and Cervical Cancer Mortality Prevention Act.pdf Supplementary Document
Revised WPHSS_Supp St_Part B_09 14 17.docx Supporting Statement B
Eligibility Screener Other-CATI script
Women's Preventive Health Services Survey Form

All Historical Document Collections

201702-0920-004

Approved with change

New collection (Request for a new OMB Control Number)

2017-03-02

OMB Details

Women's Preventive Health Services Survey

Federal Enterprise Architecture: Health - Health Care Services

Form none	WPHSS questionnaire	Fillable Fileable	Form
Form none	Survey screenshots - Spanish	Fillable Fileable	Form
Form none	Survey screenshots - English	Fillable Fileable	Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.