Information Collection

Father Pre-Natal Interview

IC 193569 under ICR 201407-0925-005 · OMB 0925-0593.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 7.1 Father Pre-Natal Interview	Form and Instruction
7.1 Survey FatherPreNatalQuestionnaireAdult.docx	Form and Instruction
7.2 Survey FatherPreNatalQuestionnaireHousehold.docx	Form and Instruction
Attach 9. Informed Consent Form - Fathers and Parental Partners.docx nformedConsentFormFathersandParentalPartners	IC Document
Attach 13. Multi-Mode Visit Information Script.docx MultiModeVisitInformationScript	IC Document

IC Title:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	7.1	Survey	FatherPreNatalQuestionnaireAdult.docx		Yes	Yes	Paper Only
Form and Instruction	7.2	Survey	FatherPreNatalQuestionnaireHousehold.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: 317

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	317	317
Annual IC Time Burden (Hours)	338	338
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
nformedConsentFormFathersandParentalPartners	Attach 9. Informed Consent Form - Fathers and Parental Partners.docx	07/24/2014
MultiModeVisitInformationScript	Attach 13. Multi-Mode Visit Information Script.docx	07/24/2014

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