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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.