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Att 3b_Enrollment
The Girl Power Project Efficacy Trial
OMB: 0920-1134
IC ID: 220113
OMB.report
HHS/CDC
OMB 0920-1134
ICR 201602-0920-008
IC 220113
( )
Documents and Forms
Document Name
Document Type
Att 3b Enrollment Questions.pdf
Other-Screenshots
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att 3b_Enrollment
Agency IC Tracking Number:
16OJ
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-Screenshots
Att 3b Enrollment Questions.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the US Population
FR Citation:
49 FR 47413
Number of Respondents:
1,200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
1,200
0
1,200
0
0
0
Annual IC Time Burden (Hours)
100
0
100
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
