Mother Questionnaire

National Birth Defects Prevention Study

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0010 can be found here:

Documents and Forms

Document Name Document Type
Mother Questionnaire Form
Mother Questionnaire Attachment E_NBDPS CATI 04-06-10.pdf Form
Attachment I_Att23 Intro Phone Scripts_10-11.doc Att I - Intro Script IC Document

Information Collection (IC) Details

IC Title:	Mother Questionnaire	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	none	Mother Questionnaire	Attachment E_NBDPS CATI 04-06-10.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 73 FR 6727

Number of Respondents: 3,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	3,840	3,840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att I - Intro Script	Attachment I_Att23 Intro Phone Scripts_10-11.doc	04/23/2012

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