Information Collection

Two-Tier (High): 12-Month Visit Interview

IC 196545 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 78.1 Two-Tier (High): 12-Month Visit Interview Form and Instruction
78.1 Survey 12-Month Mother Interview 20110211.docx Form and Instruction
78.2 Survey 12-Month Mother SAQ 20110211.doc Form and Instruction
12-Month Visit Information Sheet 20110211.docx 12-Month Visit Information Sheet 20110211 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Two-Tier (High): 12-Month Visit 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	78.1	Survey	12-Month Mother Interview 20110211.docx		Yes	Yes	Paper Only
Form and Instruction	78.2	Survey	12-Month Mother SAQ 20110211.doc		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: 1,644	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	1,644	1,644
Annual IC Time Burden (Hours)	822	822
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
12-Month Visit Information Sheet 20110211	12-Month 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.