Partners/Fathers

Evaluation of Pregnant and Postpartum Women (PPW)

Documents and Forms

Document Name Document Type
Form Instrument for Par Partners/Fathers Form and Instruction
Instrument for Par Instrument for Partners-Fathers Attachment C-1 - Instrument for Partners-Fathers.pdf Form and Instruction
Attachment C-2 - Supporting Documents for Partners-Fathers.pdf Supporting Documents for Partners-Fathers IC Document

Information Collection (IC) Details

IC Title:	Partners/Fathers	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 and Instruction	Instrument for Partners-Fathers	Instrument for Partners-Fathers	Attachment C-1 - Instrument for Partners-Fathers.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 110	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	220	220
Annual IC Time Burden (Hours)	37	37
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Documents for Partners-Fathers	Attachment C-2 - Supporting Documents for Partners-Fathers.pdf	10/06/2010

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