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Federal forms, ICRs, and supporting documents

Information Collection

Pregnancy Loss, Stillbirth, & Neonatal Death Interview

IC 202207 under ICR 201407-0925-005 · OMB 0925-0593.

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Pregnancy Loss, Stillbirth, & Neonatal Death Interview
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 19.1 Survey PregnancyLossStillbirthNeonatalDeathQuestionnaire.docx Yes Yes Paper Only
Form and Instruction 19.2 Survey PregnancyLossStillbirthNeonatalDeathSAQ.docx Yes Yes Paper Only
Instruction PLSNDPhoneMedDeathReleaseLetter.docx Yes Yes Paper Only
Instruction PLSNDPhoneMedReleaseLetter.docx Yes Yes Paper Only

General Science and Innovation Scientific and Technological Research and Innovation

 

13 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 13 0 0 0 0 13
Annual IC Time Burden (Hours) 4 0 0 0 0 4
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
PLSNDSAQReleaseLetter PLSNDSAQReleaseLetter.docx 11/08/2013
PLSNDMailRemindCallScript PLSNDMailRemindCallScript.docx 11/08/2013
PLSNDPhoneRemindCallScript PLSNDPhoneRemindCallScript.docx 11/08/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.