Information Collection

Enhanced Household: Pre-Pregnancy Interview

IC 193562 under ICR 201103-0925-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 12.1 Enhanced Household: Pre-Pregnancy Interview	Form and Instruction
Refusal of Bio Env Samples 20110211.docx	Instruction
12.1 Survey Pre-Pregnancy Interview 20110211.doc	Form and Instruction
Pre-Pregnancy Visit Information Sheet 20110211.docx Pre-Pregnancy Visit Information Sheet 20110211	IC Document

IC Title:

Enhanced Household: Pre-Pregnancy Interview

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	12.1	Survey	Pre-Pregnancy Interview 20110211.doc		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: 211

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	Previously Approved
Annual Number of Responses for this IC	211	211
Annual IC Time Burden (Hours)	158	158
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Pre-Pregnancy Visit Information Sheet 20110211	Pre-Pregnancy 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.