Information Collection

Screening for the Women's Health Survey

IC 214583 under ICR 201501-0920-012 · OMB 0920-1065.

Documents and Forms

Document Name Document Type
Att 3 Women's Health Survey (Screening).pdf Other-WORD
Att 3 Women's Health Survey (Screening).pdf Other-WORD

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Screening for the Women's Health Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Att 3 Women's Health Survey (Screening).pdf		Yes	Yes	Fillable Printable
Other-WORD			Att 3 Women's Health Survey (Screening).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 606	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	606	606
Annual IC Time Burden (Hours)	30	30
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.