Information Collection

Two Tier (High): Pre-Pregnancy Interview

IC 193575 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⚠️ Notice: This information collection may be referencing outdated material.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 4 Two Tier (High): Pre-Pregnancy Interview	Form and Instruction
4 Survey Pre-pregnancy interview July Launch 20100714.docx	Form and Instruction
Pre--pregnancy interview July Launch VIS 20100615.pdf Pre--pregnancy interview July Launch VIS 20100615	IC Document

IC Title:

Two Tier (High): Pre-Pregnancy Interview

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 and Instruction	4	Survey	Pre-pregnancy interview July Launch 20100714.docx		Yes	Yes	Paper Only

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: 761

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
Annual Number of Responses for this IC	761	761
Annual IC Time Burden (Hours)	571	571
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Pre--pregnancy interview July Launch VIS 20100615	Pre--pregnancy interview July Launch VIS 20100615.pdf	06/15/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.