OS Participants

Women's Health Initiative Observational Study (NHLBI)

Documents and Forms

Document Name Document Type
Form 33 OS Participants Form and Instruction
33 Medical History Update F33-OMB-2013.pdf Form and Instruction
20 Personal Information Update Form 20.pdf Form and Instruction
151 Activities of Daily Life WHI Form 151 Activities of Daily Life.pdf Form and Instruction
156 Supplemental Questionaire F156 Supplemental-OMB-01-22-13.pdf Form and Instruction
F156S Supplemental OMB-1-22-13.pdf F156S Supplemental OMB-1-22-13 IC Document

Information Collection (IC) Details

IC Title:	OS Participants	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	33	Medical History Update	F33-OMB-2013.pdf	No	No	Paper Only
Form and Instruction	20	Personal Information Update	Form 20.pdf	No	No	Paper Only
Form and Instruction	151	Activities of Daily Life	WHI Form 151 Activities of Daily Life.pdf	No	No	Paper Only
Form and Instruction	156	Supplemental Questionaire	F156 Supplemental-OMB-01-22-13.pdf	No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41,495	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-41,495	41,495
Annual IC Time Burden (Hours)	-13,832	13,832
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
F156S Supplemental OMB-1-22-13	F156S Supplemental OMB-1-22-13.pdf	05/29/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.