Provider-Based: Father 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⚠️ Notice: This information collection may be referencing outdated material.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 40.1 Provider-Based: Father Interview Form and Instruction
40.1 Survey Father Interview 20110211.docx Form and Instruction
Fathers Visit Information Sheet 20110211.docx Fathers Visit Information Sheet 20110211 IC Document

Information Collection (IC) Details

IC Title:	Provider-Based: Father Interview	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	40.1	Survey	Father Interview 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: 275	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	275	275
Annual IC Time Burden (Hours)	69	69
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fathers Visit Information Sheet 20110211	Fathers 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.