Information Collection

2019 004 Women%27s Health Desktop SP_10.16.18

IC 233721 under ICR 201805-1090-003 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 004 2019 004 Women%27s Health Desktop SP_10.16.18	Form and Instruction
004 2019 004 Women%27s Health Desktop SP_10.16.18 2019 004 Women%27s Health Desktop SP_10.16.18.xlsx	Form and Instruction
Womenshealth OMB Form 10.16.2018 signed.pdf Womenshealth OMB Form 10.16.2018 signed	IC Document
Spanish Desktop Survey 1090-0008 Survey Mapping Document.docx Spanish Desktop Survey 1090-0008 Survey Mapping Document	IC Document

IC Title:

2019 004 Women%27s Health Desktop SP_10.16.18

Agency IC Tracking Number:

004

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	004	2019 004 Women%27s Health Desktop SP_10.16.18	2019 004 Women%27s Health Desktop SP_10.16.18.xlsx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Womenshealth OMB Form 10.16.2018 signed	Womenshealth OMB Form 10.16.2018 signed.pdf	10/25/2018
Spanish Desktop Survey 1090-0008 Survey Mapping Document	Spanish Desktop Survey 1090-0008 Survey Mapping Document.docx	10/25/2018

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