View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

A Tailored Communications Campaign Segment to Prevent Pregnancy-Related Deaths Among American Indian/Alaska Native Women 0920-0572-21HV
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0572 No   Paper Only
Form 0920-0572 No   Paper Only
Other-Password Protected file No   Fillable Fileable
Other-Password Protected file No   Fillable Fileable

Health Public Health Monitoring

 

272 0
   
Individuals or Households
 
   0 %

  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 272 0 272 0 0 0
Annual IC Time Burden (Hours) 115 0 115 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Background Informatino 08/25/2021
Consent Form 08/25/2021
Email Notification Script 08/25/2021
HMTS Review Form _ AIAN Women 08/25/2021
Video Concept Clearance 311241 08/25/2021
List of Attachments 08/25/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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