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

View Information Collection (IC)

Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Reporting System 0920-0612 (18YZ)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Yes Yes Fillable Fileable
Form and Instruction 0920-0612 Yes Yes Fillable Fileable
Other-Screenshot Yes Yes Fillable Fileable
Other-Screenshot Yes Yes Fillable Fileable

Health Public Health Monitoring

 

24 0
   
State, Local, and Tribal Governments
 
   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 48 0 6 0 0 42
Annual IC Time Burden (Hours) 1,152 0 144 0 0 1,008
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment 4 Screen Shots of Portal 10/29/2013
Exhibits 1. Overview of Proposed Improvements 04/10/2018
Request for Nonmaterial/Non-substantive Change to an OMB Approved 04/10/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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