Information Collection

Testing of automated self-response methods for collecting the reduced content version of NCS pregnancy status follow-up contacts

IC 190084 under ICR 200802-0925-003 · OMB 0925-0590.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0590 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Testing of automated self-response methods for collecting the reduced content version of NCS pregnancy status follow-up contacts	Form and Instruction
1 survey 3. Appendix A - NCS Formative Research Recruiting Questionnaire - Automated self-response.docx	Form and Instruction
2 survey 7. Appendix E - Pregnancy Screener for self-response test.docx	Form and Instruction
3 survey 8.Appendix F - Consent Form to Receive Text Messages.docx	Form and Instruction
4 survey 9. Appendix G - Interactive Voice Response Phone Follow-up Script.docx	Form and Instruction
5 survey 11. Appendix I - Web E-mail Follow-up Script.docx	Form and Instruction
6 survey 10. Appendix H - Text Message Follow-up Script.docx	Form and Instruction
2. Automated Self-response Formative Research Cover Memo.docx 2	IC Document
1 Submission of Information Collection - Automated Self-response (2).doc 1 Submission of Information Collection - Automated Self-response (2)	IC Document
4. Appendix B - Flowchart for 6-week Contact.pdf 4	IC Document
5. Appendix C - Flowchart for 12-week Contact.pdf 5	IC Document
6. Appendix D - Consent Form for Westat Formative Research Study.docx 6	IC Document
12. Appendix J - Westat IRB Expedited Approval.docx 12	IC Document
0925-0590 Terms of Clearance.doc Terms of Clearance	IC Document

IC Title:

Testing of automated self-response methods for collecting the reduced content version of NCS pregnancy status follow-up contacts

Agency IC Tracking Number:

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	1	survey	3. Appendix A - NCS Formative Research Recruiting Questionnaire - Automated self-response.docx	Yes	Yes	Paper Only
Form and Instruction	2	survey	7. Appendix E - Pregnancy Screener for self-response test.docx	Yes	Yes	Paper Only
Form and Instruction	3	survey	8.Appendix F - Consent Form to Receive Text Messages.docx	Yes	Yes	Paper Only
Form and Instruction	4	survey	9. Appendix G - Interactive Voice Response Phone Follow-up Script.docx	Yes	Yes	Paper Only
Form and Instruction	5	survey	11. Appendix I - Web E-mail Follow-up Script.docx	Yes	Yes	Paper Only
Form and Instruction	6	survey	10. Appendix H - Text Message Follow-up Script.docx	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	200	0	0	0	0	0
Annual IC Time Burden (Hours)	100	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2	2. Automated Self-response Formative Research Cover Memo.docx	07/16/2009
1 Submission of Information Collection - Automated Self-response (2)	1 Submission of Information Collection - Automated Self-response (2).doc	07/16/2009
4	4. Appendix B - Flowchart for 6-week Contact.pdf	07/16/2009
5	5. Appendix C - Flowchart for 12-week Contact.pdf	07/16/2009
6	6. Appendix D - Consent Form for Westat Formative Research Study.docx	07/16/2009
12	12. Appendix J - Westat IRB Expedited Approval.docx	07/16/2009
Terms of Clearance	0925-0590 Terms of Clearance.doc	09/18/2009

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