Information Collection

Baseline Care Survey for Pregnant Adolescent

IC 10423 under ICR 200809-0990-002 · OMB 0990-0290.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0990-0290 Baseline Care Survey for Pregnant Adolescent	Form
0990-0290 Preganacy Teen 0990-0290Appendix B_Draft Care Pregnant Baseline for grantees_OMB_09-02-08_MK-JG-KLL.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form	0990-0290	Preganacy Teen	0990-0290Appendix B_Draft Care Pregnant Baseline for grantees_OMB_09-02-08_MK-JG-KLL.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

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	Previously Approved
Annual Number of Responses for this IC	10,000	-2,600	12,600
Annual IC Time Burden (Hours)	3,833	-2,467	6,300
Annual IC Cost Burden (Dollars)	0	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.