OMB control number

Women's Preventive Health Services Survey

OMB 0920-1200 · HHS/CDC.

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 is listed under ICR 201702-0920-004.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
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All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201702-0920-004	New collection (Request for a new OMB Control Number)	2017-03-02		Approved with change

OMB Details

Women's Preventive Health Services Survey

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
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.