Information Collection

POP - POST ENROLLMENT_F/U Phone Call Script and Pregnancy Ref Form (Mother)

IC 224023 under ICR 201610-0920-010 · OMB 0920-1171.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1171 can be found here:

Documents and Forms

Document Name Document Type
Attachment 21.d. Follow-up Call Items Checklist SEED 3.docx Other-WORD
Attachment 7.a. Pregnancy Reference Form Script SEED 3_9-19-16.doc Other-WORD
Attachment 7.b. Pregnancy Reference Form SEED 3_9_19_16.docx Other-WORD

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	POP - POST ENROLLMENT_F/U Phone Call Script and Pregnancy Ref Form (Mother)	Agency IC Tracking Number:	16PA

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-WORD	Attachment 21.d. Follow-up Call Items Checklist SEED 3.docx	No	Paper Only
Other-WORD	Attachment 7.a. Pregnancy Reference Form Script SEED 3_9-19-16.doc	No	Fillable Fileable
Other-WORD	Attachment 7.b. Pregnancy Reference Form SEED 3_9_19_16.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 301	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	301	301
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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