Information Collection

Pregnancy Health Care Log (PB, EH, TT-HI)

IC 193567 under ICR 201109-0925-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 17.1 Pregnancy Health Care Log (PB, EH, TT-HI)	Form and Instruction
17.1 Log Pregnancy Health Care Log 20110211.doc	Form and Instruction

IC Title:

Pregnancy Health Care Log (PB, EH, TT-HI)

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	17.1	Log	Pregnancy Health Care Log 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: 4,088

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	4,088	4,088
Annual IC Time Burden (Hours)	1,349	1,349
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.