Information Collection

Birth Visit Interview (PB, EH, TT-HI)

IC 193570 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 20.1 Birth Visit Interview (PB, EH, TT-HI) Form and Instruction
20.1 Survey A.1.1 Birth Visit Instrument (EH, PB, HI).docx Form and Instruction
Note to File - Birth Visit - Umbilical Cord Blood Collection.docx Note to File - Birth Visit - Umbilical Cord Blood Collection IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Birth Visit Interview (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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	20.1	Survey	A.1.1 Birth Visit Instrument (EH, PB, HI).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: 2,672	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	2,672	2,672
Annual IC Time Burden (Hours)	1,069	1,069
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Note to File - Birth Visit - Umbilical Cord Blood Collection	Note to File - Birth Visit - Umbilical Cord Blood Collection.docx	04/08/2011

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