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Enhanced Household: Pre-Pregnancy Interview
Recruitment Strategy Substudy for the National Children's Study (NICHD)
OMB: 0925-0593
IC ID: 193562
OMB.report
HHS/NIH
OMB 0925-0593
ICR 201103-0925-001
IC 193562
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0593 can be found here:
2014-07-25 - No material or nonsubstantive change to a currently approved collection
2014-01-13 - Revision of a currently approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
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:
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
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:
211
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
211
0
0
0
0
211
Annual IC Time Burden (Hours)
158
0
0
0
0
158
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.