Information Collection

High Probability Women w/Pre-pregnancy Visit

IC 184273 under ICR 201007-0925-001 · OMB 0925-0593.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 High Probability Women w/Pre-pregnancy Visit	Form and Instruction
1 Survey A.1.2.a P1 Interview.doc	Form and Instruction
1 Survey A.1.2.b P1_P2_P4 month phone calls 1-20-08 OMB Version.doc	Form and Instruction
1 Survey A.2.1.b 1-P1 (Pre-Pregnancy) FFQ (3 months).doc	Form and Instruction
1 Survey A.2.1.a 1-P1 T1 Dietary Script.doc	Form and Instruction
1 Survey A.2.1.a 3-3-Day Dietary Checklist.doc	Form and Instruction
1 Survey A.2.1.b 1-P1 (Pre-Pregnancy) FFQ (3 months).doc	Form and Instruction
1 Survey A.2.1.h Participant Satisfaction Questionnaire.doc	Form and Instruction
1 Survey A.2.3.a P1 Pre-Visit Instructions.doc	Form and Instruction
1 Survey A.2.3.f 1-Urine Data Collection Instructions.doc	Form and Instruction
1 Survey A.2.3.g 1-Urine Pregnancy Test Instructions.doc	Form and Instruction
1 Survey A.2.3.g 2-Urine Pregnancy Test Data Collection Form.doc	Form and Instruction
1 Survey A.2.3.h 1-Vaginal Swabs Collection Instructions.doc	Form and Instruction
1 Survey A.2.3.h 2-Vaginal Swabs Data Collection Form.doc	Form and Instruction
1 Survey A.2.3.l 1-Blood Draw Data Collection Form P1.doc	Form and Instruction
1 Survey A.2.3.n 1-T3 Letter-One Air Badge.doc	Form and Instruction
1 Survey A.2.3.n 2-T3 letter-Two Air Badges.doc	Form and Instruction
1 Survey A.2.3.s 1-T1 Environmental T1.doc	Form and Instruction
1 Survey A.2.3.s 2-Environmental Questions 6 month and 12 month.doc	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

High Probability Women w/Pre-pregnancy Visit

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Survey	A.2.3.l 1-Blood Draw Data Collection Form P1.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.n 1-T3 Letter-One Air Badge.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.n 2-T3 letter-Two Air Badges.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.s 1-T1 Environmental T1.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.s 2-Environmental Questions 6 month and 12 month.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.1.2.a P1 Interview.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.1.2.b P1_P2_P4 month phone calls 1-20-08 OMB Version.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.b 1-P1 (Pre-Pregnancy) FFQ (3 months).doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.a 1-P1 T1 Dietary Script.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.a 3-3-Day Dietary Checklist.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.b 1-P1 (Pre-Pregnancy) FFQ (3 months).doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.1.h Participant Satisfaction Questionnaire.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.a P1 Pre-Visit Instructions.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.f 1-Urine Data Collection Instructions.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.g 1-Urine Pregnancy Test Instructions.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.g 2-Urine Pregnancy Test Data Collection Form.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.h 1-Vaginal Swabs Collection Instructions.doc	Yes	Yes	Paper Only
Form and Instruction	1	Survey	A.2.3.h 2-Vaginal Swabs Data Collection Form.doc	Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 380

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-646	646
Annual IC Time Burden (Hours)	-601	601
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.