Women's Health Needs STUDY_QUESTIONNAIRE

Women’s Health Needs Study: The Health of US-Resident Women from Countries with Prevalent Female Genital Mutilation/Cutting (FGM/C)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1264 can be found here:

Documents and Forms

Document Name Document Type
Att H1 Initial Pilot Questionnaire WHNS_ENGLISH_08092018.docx Other-WORD English translations
Att H2 Initial Pilot Questionnaire WHNS_Somali.docx Other-WORD Somali translations
Att H3 Initial Pilot Questionnaire WHNS_Swahili.docx Other-WORD Swahili translations
Att H4 Initial Pilot Questionnaire WHNS_Arabic.docx Other-WORD Arabic translations
Att H5 Initial Pilot Questionnaire WHNS_Armharic.docx Other-WORD Armharic translations

Information Collection (IC) Details

IC Title:	Women's Health Needs STUDY_QUESTIONNAIRE	Agency IC Tracking Number:	0920-18JC

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD English translations	Att H1 Initial Pilot Questionnaire WHNS_ENGLISH_08092018.docx	No	Fillable Fileable
Other-WORD Somali translations	Att H2 Initial Pilot Questionnaire WHNS_Somali.docx	No	Paper Only
Other-WORD Swahili translations	Att H3 Initial Pilot Questionnaire WHNS_Swahili.docx	No	Paper Only
Other-WORD Arabic translations	Att H4 Initial Pilot Questionnaire WHNS_Arabic.docx	No	Paper Only
Other-WORD Armharic translations	Att H5 Initial Pilot Questionnaire WHNS_Armharic.docx	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	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.