Information Collection

Retrospective Pregnancy Interview

IC 210036 under ICR 201407-0925-005 · OMB 0925-0593.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 45.1 Retrospective Pregnancy Interview	Form and Instruction
45.1 Survey RetrospectivePregnancyBirthCohortQuestionnaireAdult.docx	Form and Instruction
45.3 Survey RetrospectivePregnancyBirthCohortSAQ.docx	Form and Instruction
45.2 Survey RetrospectivePregnancyBirthCohortQuestionnaireHousehold.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	45.1	Survey	RetrospectivePregnancyBirthCohortQuestionnaireAdult.docx	Yes	Yes	Paper Only
Form and Instruction	45.3	Survey	RetrospectivePregnancyBirthCohortSAQ.docx	Yes	Yes	Paper Only
Form and Instruction	45.2	Survey	RetrospectivePregnancyBirthCohortQuestionnaireHousehold.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: 422

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	422	422
Annual IC Time Burden (Hours)	331	331
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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