Information Collection

Beta Test of PregSource™ Crowd-Sourcing to Understand Pregnancy

IC 224334 under ICR 201410-0925-002 · OMB 0925-0643.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0643 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Beta Test of PregSource™ Crowd-Sourcing to Understand Pregnancy	Form
1 PregSourceBeta Test Survey 0925-0643_Substudy_PregSourceBetaTest_Survey.pdf	Form
0925-0643_Substudy_PregSourceBetaTest_ClearanceRequest.doc PregSource Beta Test Clearance request	IC Document
0925-0643_Substudy_PregSourceBetaTest_Emails.docx PregSource Beta Test Emails	IC Document

IC Title:

Beta Test of PregSourceâ¢ Crowd-Sourcing to Understand Pregnancy

Agency IC Tracking Number:

IC Status: New

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	1	PregSourceBeta Test Survey	0925-0643_Substudy_PregSourceBetaTest_Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PregSource Beta Test Clearance request	0925-0643_Substudy_PregSourceBetaTest_ClearanceRequest.doc	11/07/2016
PregSource Beta Test Emails	0925-0643_Substudy_PregSourceBetaTest_Emails.docx	11/07/2016

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