Mother's 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⚠️ Notice: This information collection may be referencing outdated material.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's Questionnaire Form
BD-STEPS Questionnaire AttG_BDSTEPS_CATI_7 0_2014-9-24_Clean.pdf Form
BD-STEPS Questionnaire - Spanish AttG2_BDSTEPS_CATI_Spanish.pdf Form
AttL_IntroPhoneScript_April6_2015.pdf L1 - Consent IC Document
AttL2_IntroPhoneScript_Spanish.pdf L2 - Consent - Spanish IC Document

Information Collection (IC) Details

IC Title:	Mother's 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 Questionnaire	AttG_BDSTEPS_CATI_7 0_2014-9-24_Clean.pdf		Yes	Yes	Fillable Fileable
Form	none	BD-STEPS Questionnaire - Spanish	AttG2_BDSTEPS_CATI_Spanish.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 1,925	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,925	1,925
Annual IC Time Burden (Hours)	1,444	1,444
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
L1 - Consent	AttL_IntroPhoneScript_April6_2015.pdf	06/10/2015
L2 - Consent - Spanish	AttL2_IntroPhoneScript_Spanish.pdf	06/10/2015

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