Information Collection

Mapping and Questionnaire Documents IA 30742 A1 (NIH)

IC 235312 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⚠️ Notice: This information collection may be referencing outdated material.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 NIH NCCIH Mobile I Mapping and Questionnaire Documents IA 30742 A1 (NIH)	Form and Instruction
NIH NCCIH Mobile I NIH NCCIH Mobile Informationa 09282018_DOT NIH NCCIH Mobile Informationa 09282018_DOT.xlsx	Form and Instruction
NIH-NCCIH Desktop NIH-NCCIH Desktop Browse Questionnaire_092517 NIH-NCCIH Desktop Browse Questionnaire_092517.xlsx	Form and Instruction
1090-0008 Survey Mapping Document (NIH) IA 30742 A1_draft.xlsx 1090-0008 Survey Mapping Document (NIH) IA 30742 A1_draft	IC Document
NIH OMB Form 11.13.2018 IA 30742 A1.pdf NIH OMB Form 11.13.2018 IA 30742 A1	IC Document

IC Title:

Mapping and Questionnaire Documents IA 30742 A1 (NIH)

Agency IC Tracking Number:

30742 A1 (NIH)

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	NIH NCCIH Mobile Informationa 09282018_DOT	NIH NCCIH Mobile Informationa 09282018_DOT	NIH NCCIH Mobile Informationa 09282018_DOT.xlsx		Yes	Yes	Fillable Fileable
Form and Instruction	NIH-NCCIH Desktop Browse Questionnaire_092517	NIH-NCCIH Desktop Browse Questionnaire_092517	NIH-NCCIH Desktop Browse Questionnaire_092517.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 (NIH) IA 30742 A1_draft	1090-0008 Survey Mapping Document (NIH) IA 30742 A1_draft.xlsx	03/13/2019
NIH OMB Form 11.13.2018 IA 30742 A1	NIH OMB Form 11.13.2018 IA 30742 A1.pdf	03/13/2019

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