Information Collection

NHANES Birth Certificate Linkage Study -- Pregnant Women (Interview/Consent)

IC 201297 under ICR 201202-0920-006 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 5a_BC Questionnaire.docx	Other-WORD
Att 3_BC Letter.doc Att 3_BC Letter	IC Document
Att 4_ BC Consent.doc Att 4_ BC Consent	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Other-WORD			Att 5a_BC Questionnaire.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the US Population

FR Citation: 49 FR 37693

Number of Respondents: 750

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 3_BC Letter	Att 3_BC Letter.doc	02/10/2012
Att 4_ BC Consent	Att 4_ BC Consent.doc	02/10/2012

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