Information Collection

Maternal Obesity

IC 230147 under ICR 201605-0925-007 · OMB 0925-0046.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0046 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Maternal Obesity	Form
1 Online Prescreener Attachment 2_Online Prescreener_NICHD_NCMHEP Maternal Obesity_0925-0046.pdf	Form
2 Telephone Screener NICHD NCMHEP Maternal Obesity Attachment 3_Telephone Screener_NICHD_NCMHEP Maternal Obesity_0925-0046 rev 2.16.18.docx	Form
3 Discussion Guide NICHD NCMHEP Maternal Obesity Attachment 4_Discussion Guide_NICHD_NCMHEP Maternal Obesity_0925-0046.docx	Form
Mini SSA_Maternal Obesity_0925-0046 rev 2.16.18.docx Mini SSA Maternal Obesity	IC Document
Attachment 5_Messaging and visual testing materials for Discussion Guide_NICHD_NCMHEP Maternal Obesity_0925-0046.docx Messaging and Visual Testing material for Discussion Guide	IC Document
Attachment 6_Images for Discussion Guide_NICHD_NCMHEP Maternal Obesity_0925-0046.pdf Images for Discussion Guide	IC Document

IC Title:

Maternal Obesity

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Online Prescreener	Attachment 2_Online Prescreener_NICHD_NCMHEP Maternal Obesity_0925-0046.pdf	Yes	Yes	Fillable Fileable
Form	2	Telephone Screener NICHD NCMHEP Maternal Obesity	Attachment 3_Telephone Screener_NICHD_NCMHEP Maternal Obesity_0925-0046 rev 2.16.18.docx	No		Paper Only
Form	3	Discussion Guide NICHD NCMHEP Maternal Obesity	Attachment 4_Discussion Guide_NICHD_NCMHEP Maternal Obesity_0925-0046.docx	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	68	68
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini SSA Maternal Obesity	Mini SSA_Maternal Obesity_0925-0046 rev 2.16.18.docx	02/16/2018
Messaging and Visual Testing material for Discussion Guide	Attachment 5_Messaging and visual testing materials for Discussion Guide_NICHD_NCMHEP Maternal Obesity_0925-0046.docx	02/16/2018
Images for Discussion Guide	Attachment 6_Images for Discussion Guide_NICHD_NCMHEP Maternal Obesity_0925-0046.pdf	02/16/2018

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