Information Collection

Survey of Knowledge, Attitudes and Practice Managment Patterns of Obstetricians Regarding Stillbirth Preganancy Outcomes

IC 178495 under ICR 200701-0920-005 · OMB 0920-0742.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attach C_Stillbirth Management Provider Survey.doc	Instruction
Attach D_HHS_Letterhead(edits)12 11 2006.doc Attach D_HHS_Letterhead(edits)12 11 2006	IC Document
Attach E_HHS letterhead.doc Attach E_HHS letterhead	IC Document
Attach F_G_Sample_Reminder_Postcard1.doc Attach F_G_Sample_Reminder_Postcard1	IC Document
Attach I Affidavit of Nondisclosure_draft_09 13 06.doc Attach I Affidavit of Nondisclosure_draft_09 13 06	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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
Instruction			Attach C_Stillbirth Management Provider Survey.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attach D_HHS_Letterhead(edits)12 11 2006	Attach D_HHS_Letterhead(edits)12 11 2006.doc	01/09/2007
Attach E_HHS letterhead	Attach E_HHS letterhead.doc	01/09/2007
Attach F_G_Sample_Reminder_Postcard1	Attach F_G_Sample_Reminder_Postcard1.doc	01/09/2007
Attach I Affidavit of Nondisclosure_draft_09 13 06	Attach I Affidavit of Nondisclosure_draft_09 13 06.doc	01/09/2007

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