Information Collection

Mapping and Questionnaire Documents IA 30660 A3 (OWH

IC 235019 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⚠️ Notice: This information collection may be referencing outdated material.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 30660 Mapping and Questionnaire Documents IA 30660 A3 (OWH	Form and Instruction
30660 Q_GirlsHealth_Web_Browse_20170808 Q_GirlsHealth_Web_Browse_20170808.xlsx	Form and Instruction
30660 Q_GirlsHealthV3_Mobile_Browse_20170808 Q_GirlsHealthV3_Mobile_Browse_20170808.xlsx	Form and Instruction
30660 Q_WomensHealthV3_Web_Browse_20181129_DOT Q_WomensHealthV3_Web_Browse_20181129_DOT.xlsx	Form and Instruction
30660 Q_WomensHealthV3_Web_Browse_20181129_DOT_1 Q_WomensHealthV3_Web_Browse_20181129_DOT_1.xlsx	Form and Instruction
30660 Women's Health Desktop SP_20181116_DOT Women's Health Desktop SP_20181116_DOT.xlsx	Form and Instruction
1090-0008 Survey Mapping Document (OWH NWHIC) IA 30660 A3.xlsx 1090-0008 Survey Mapping Document (OWH NWHIC) IA 30660 A3	IC Document
OWH OMB Form 11.13.2018 IA 30660 A3.pdf OWH OMB Form 11.13.2018 IA 30660 A3	IC Document

IC Title:

Mapping and Questionnaire Documents IA 30660 A3 (OWH

Agency IC Tracking Number:

30660A3

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	30660	Q_GirlsHealth_Web_Browse_20170808	Q_GirlsHealth_Web_Browse_20170808.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30660	Q_GirlsHealthV3_Mobile_Browse_20170808	Q_GirlsHealthV3_Mobile_Browse_20170808.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30660	Q_WomensHealthV3_Web_Browse_20181129_DOT	Q_WomensHealthV3_Web_Browse_20181129_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30660	Q_WomensHealthV3_Web_Browse_20181129_DOT_1	Q_WomensHealthV3_Web_Browse_20181129_DOT_1.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30660	Women's Health Desktop SP_20181116_DOT	Women's Health Desktop SP_20181116_DOT.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
1090-0008 Survey Mapping Document (OWH NWHIC) IA 30660 A3	1090-0008 Survey Mapping Document (OWH NWHIC) IA 30660 A3.xlsx	02/21/2019
OWH OMB Form 11.13.2018 IA 30660 A3	OWH OMB Form 11.13.2018 IA 30660 A3.pdf	02/21/2019

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