Information Collection

Pregnancy Activities

IC 184277 under ICR 200803-0925-005 · OMB 0925-0593.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
Form 1 Survey Pregnancy Activities	Form and Instruction
A.2.3.u Environmental Letter -- Water.doc	Other-Results Letter
1 Survey A.1.3.c T16_17 week phone call_Revised.doc	Form and Instruction
1 Survey A.1.3.a T1 Mother Interview_Revised.doc	Form and Instruction
1 Survey A.1.3.d T3 Interview_Revised.doc	Form and Instruction
1 Survey A.1.3.e T36 week phone call_Revised.doc	Form and Instruction
1 Survey A.2.1.a 2-T3 Dietary Script.doc	Form and Instruction
1 Survey A.2.1.a.3 3-Day Food Checklist_Revised.pdf	Form and Instruction
1 Survey A.2.1.b.2-T1 FFQ (3 months)_Revised.pdf	Form and Instruction
1 Survey A.2.1.b.3-T3 FFQ (3 months)_Revised.pdf	Form and Instruction
1 Survey A.2.1.c Pregnancy Diary.xls	Form and Instruction
1 Survey A.2.1.e 1-Cover.doc	Form and Instruction
1 Survey A.2.1.e 2-Instructions for Log.doc	Form and Instruction
1 Survey A.2.1.e 3-Pregnancy Care Log.doc	Form and Instruction
1 Survey A.2.1.f Time Place and Activity Diary_Revised.doc	Form and Instruction
1 Survey A.2.3.b 1-T1 First Pre-Visit Instructions.doc	Form and Instruction
1 Survey A.2.3.b 2-T1 Prior Pre-Visit Instructions.doc	Form and Instruction
1 Survey A.2.3.c 1-T3 First Pre-Visit Instructions.doc	Form and Instruction
1 Survey A.2.3.c 2-T3 Prior Pre-Visit Instructions.doc	Form and Instruction
1 Survey A.2.3.j Adult Saliva Collection_Revised.doc	Form and Instruction
1 Survey A.2.3.j 2-Adult Saliva Data Collection Form Day 1.doc	Form and Instruction
1 Survey A.2.3.j 3-Adult Saliva Data Collection Form Day 2.doc	Form and Instruction
1 Survey A.2.3.l.2 Blood Draw Data Collection Form_Revised.doc	Form and Instruction
1 Survey A.2.3.l.4 Blood Draw Data Collection Form_Revised.doc	Form and Instruction
1 Survey A.2.3.m.1 Adult Hair Data Collection Form.doc	Form and Instruction
1 Survey A.2.3.q 1-T3_24 month One Air badge collection instructions.doc	Form and Instruction
1 Survey A.2.3.q 2-T3_24 Month One Air badge questionnaire.doc	Form and Instruction
1 Survey A.2.3.q 3-T3_24 month Two Air badges collection instructions.doc	Form and Instruction
1 Survey A.2.3.q 4-T3_24 month Two Air badges questionnaire.doc	Form and Instruction
1 Survey A.2.3.s 1-T1 Environmental T1.doc	Form and Instruction
1 Survey A.1.3.f Pregnancy Loss Form.doc	Form and Instruction
1 Survey A.2.1.l Life Experiences Survey.doc	Form and Instruction
1 Survey A.2.3.q Air Badge Questionnaire.doc	Form and Instruction
1 Survey A.2.1.a.2 P1 T1 Dietary Script_Revised.pdf	Form and Instruction
1 Survey A.2.1.e Medical Care Log_Revised.doc	Form and Instruction
1 Survey A.2.1.g Consent Evaluation Questionnaire.doc	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Pregnancy Activities

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Survey	A.2.3.j 3-Adult Saliva Data Collection Form Day 2.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.q 1-T3_24 month One Air badge collection instructions.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.q 2-T3_24 Month One Air badge questionnaire.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.q 3-T3_24 month Two Air badges collection instructions.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.q 4-T3_24 month Two Air badges questionnaire.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.s 1-T1 Environmental T1.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.a 2-T3 Dietary Script.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.c Pregnancy Diary.xls	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.e 1-Cover.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.e 2-Instructions for Log.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.e 3-Pregnancy Care Log.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.b 1-T1 First Pre-Visit Instructions.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.b 2-T1 Prior Pre-Visit Instructions.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.c 1-T3 First Pre-Visit Instructions.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.c 2-T3 Prior Pre-Visit Instructions.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.j 2-Adult Saliva Data Collection Form Day 1.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.1.3.d T3 Interview_Revised.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.1.3.a T1 Mother Interview_Revised.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.b.3-T3 FFQ (3 months)_Revised.pdf	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.f Time Place and Activity Diary_Revised.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.l Life Experiences Survey.doc	Yes	Yes	Paper Only
Other-Results Letter			A.2.3.u Environmental Letter -- Water.doc	No		Paper Only
Form and Instruction	1	Survey	A.1.3.f Pregnancy Loss Form.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.j Adult Saliva Collection_Revised.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.m.1 Adult Hair Data Collection Form.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.l.4 Blood Draw Data Collection Form_Revised.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.b.2-T1 FFQ (3 months)_Revised.pdf	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.l.2 Blood Draw Data Collection Form_Revised.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.1.3.c T16_17 week phone call_Revised.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.q Air Badge Questionnaire.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.1.3.e T36 week phone call_Revised.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.a.2 P1 T1 Dietary Script_Revised.pdf	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.g Consent Evaluation Questionnaire.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.a.3 3-Day Food Checklist_Revised.pdf	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.e Medical Care Log_Revised.doc	Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 954

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 Agency Discretion
Annual Number of Responses for this IC	6,678	6,678
Annual IC Time Burden (Hours)	4,140	4,140
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.