Information Collection

Two-Tier (High): Birth Visit Interview

IC 193580 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⚠️ Notice: This information collection may be referencing outdated material.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 30.1 Two-Tier (High): Birth Visit Interview	Form and Instruction
Refusal of Bio Env Samples 20110211.docx	Instruction
30.1 Survey Birth Visit Interview 20110211.docx	Form and Instruction
Birth Visit Information Sheet 20110211.docx Birth Visit Information Sheet 20110211	IC Document
Cord blood Collection Visit Information Sheet 20110211.docx Cord blood Collection Visit Information Sheet 20110211	IC Document

IC Title:

Two-Tier (High): 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:

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	30.1	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: 1,857

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	1,857	1,857
Annual IC Time Burden (Hours)	743	743
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Birth Visit Information Sheet 20110211	Birth Visit Information Sheet 20110211.docx	02/11/2011
Cord blood Collection Visit Information Sheet 20110211	Cord blood Collection 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.