Information Collection

Telephone Screening Interview for Birth Centers

IC 189526 under ICR 200906-0920-005 · OMB 0920-0743.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0743 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-2 Telephone Screening Interview for Birth Centers	Form
G-2 Telephone Screening Interview - Birth Centers Appendix_G-2_Telephone_Screening_Interview_-_Birth_Centers.doc	Form

IC Title:

Telephone Screening Interview for Birth Centers

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
Form	G-2	Telephone Screening Interview - Birth Centers	Appendix_G-2_Telephone_Screening_Interview_-_Birth_Centers.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 192

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	192	192
Annual IC Time Burden (Hours)	16	16
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.