Information Collection

Mental Models Study of Recruitment and Retention of Pregnant Women Into a Pregnancy Registry

IC 192427 under ICR 201004-0910-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A Interview Protocol HCP (Final).doc	Instruction
Attachment A Interview Protocol Potential PR Women (Final).doc	Instruction
Attachment A Interview Protocol Current PR Participant Women (Final).doc	Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 21 CFR 901 21 CFR 905

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Attachment A Interview Protocol HCP (Final).doc	Yes	Yes	Paper Only
Instruction	Attachment A Interview Protocol Potential PR Women (Final).doc	Yes	Yes	Paper Only
Instruction	Attachment A Interview Protocol Current PR Participant Women (Final).doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	60	60
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.