Information Collection

Pregnancy test

IC 184316 under ICR 200803-0925-006 · OMB 0925-0543.

Documents and Forms

Document Name Document Type
Form 1.m Pregnancy test Form and Instruction
1.m Survey Attachment 1.m. Pregnancy Test Instruction Sheet.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pregnancy test	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1.m	Survey	Attachment 1.m. Pregnancy Test Instruction Sheet.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	35	35
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.