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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.