Information Collection

Pregnancy Screener (PB, EH, TT-HI)

IC 184272 under ICR 201112-0925-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 2.1 Pregnancy Screener (PB, EH, TT-HI)	Form and Instruction
2.1 Survey Pregnancy Screener (PB) 20110211.docx	Form and Instruction
2.2 Survey Pregnancy Screener (EH) 20110211.docx	Form and Instruction
2.3 Survey Pregnancy Screener (HI, LI) 20110211.docx	Form and Instruction

IC Title:

Pregnancy Screener (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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2.1	Survey	Pregnancy Screener (PB) 20110211.docx	Yes	Yes	Paper Only
Form and Instruction	2.2	Survey	Pregnancy Screener (EH) 20110211.docx	Yes	Yes	Paper Only
Form and Instruction	2.3	Survey	Pregnancy Screener (HI, LI) 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: 68,538

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	68,538	68,538
Annual IC Time Burden (Hours)	28,786	28,786
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.