View Information Collection (IC)
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Birth Control Options (Digital and Print Communication Focus Groups) OC OC
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screener Guide in English Screener Guide - English.docx Yes No Printable Only
Other-Screener Guide in Spanish Screener Guide - Spanish.docx Yes No Printable Only
Other-Survey Instrument in English Questionnaire - English.docx Yes Yes Fillable Fileable
Other-Survey Instrument in Spanish Questionnaire - Spanish.docx Yes Yes Fillable Fileable
Other-Consent Form in English Consent Form - English.docx Yes Yes Fillable Fileable
Other-Consent Form in Spanish Consent Form - Spanish.docx Yes Yes Fillable Fileable
Other-Confirmation Letter in English Confirmation Letter - English Speaking Groups.docx Yes No Printable Only
Other-Confirmation Letter in Spanish Confirmation Letter - Spanish Speaking Groups.docx Yes No Printable Only
Other-Birth Control Chart in English Birth Control Chart in English.docx Yes No Printable Only
Other-Birth Control Chart in Spanish Birth Control Chart in Spanish.docx Yes No Printable Only

Health Consumer Health and Safety

 

72 0
   
Individuals or Households
 
   100 %

  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 72 0 72 0 0 0
Annual IC Time Burden (Hours) 108 0 108 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
OMB Approval Memo 0497 OMB Approval Memo - Birth Control Options_Digital and Print Communication 2021.docx 09/10/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.