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Assessment of Women’s Behavioral Health in Eastern Montana and Western North Dakota
OMB: 0990-0462
IC ID: 227988
OMB.report
HHS/HHSDM
OMB 0990-0462
ICR 201612-0990-003
IC 227988
( )
Documents and Forms
Document Name
Document Type
OWH_Draft KII Guide_081517.docx
Other-guide interview
OWH_OMB KII Intro Letter_081517.docx
interview
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Interviews
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-guide interview
OWH_Draft KII Guide_081517.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
40
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
40
0
40
0
0
0
Annual IC Time Burden (Hours)
40
0
40
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
interview
OWH_OMB KII Intro Letter_081517.docx
08/22/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.