Mother Questionnaire

Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS)

⚠️ Notice: This information collection may be referencing outdated material.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
BD-STEPS AttG_BDSTEPS_CATI_FullDraft_Nov8.docx Form
AttK_IntroPhoneScript_Nov5.doc K - Intro Phone Scripts 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	BD-STEPS	AttG_BDSTEPS_CATI_FullDraft_Nov8.docx		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: 1,925	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,925	-1,675	3,600
Annual IC Time Burden (Hours)	1,444	-2,396	3,840
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
K - Intro Phone Scripts	AttK_IntroPhoneScript_Nov5.doc	12/02/2013

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