Provider-Based: Birth Visit Interview

Recruitment Strategy Substudy for the National Children's Study (NICHD)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 10.1 Provider-Based: Birth Visit Interview Form and Instruction
Refusal of Bio Env Samples 20110211.docx Instruction
10.1 Survey Birth Visit Interview 20110211.docx Form and Instruction
Cord blood Collection Visit Information Sheet 20110211.docx Cord blood Collection Visit Information Sheet 20110211 IC Document
Birth Visit Information Sheet 20110211.docx Birth Visit Information Sheet 20110211 IC Document

Information Collection (IC) Details

IC Title:	Provider-Based: Birth Visit Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	10.1	Survey	Birth Visit Interview 20110211.docx		Yes	Yes	Paper Only
Instruction			Refusal of Bio Env Samples 20110211.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: 299	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	299	299
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cord blood Collection Visit Information Sheet 20110211	Cord blood Collection Visit Information Sheet 20110211.docx	02/11/2011
Birth Visit Information Sheet 20110211	Birth Visit Information Sheet 20110211.docx	02/11/2011

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