Information Collection Request

Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS)

ICR 201608-0920-002 · OMB 0920-0010 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Mother's Questionnaire Form Modified Available
Medical Record Request Form Modified Available
Occupational Questionnaires Form Modified Available
Consent for Bloodspot Retrieval Form and Instruction Modified Available
AttAA_SBsupp_IntroLetter.docx Supplementary Document Uploaded 2016-08-03 Repair queued
AttY2_IntvThankYou_BloodspotIntroLtr_Spanish.pdf Supplementary Document Uploaded 2016-08-03 Available
AttY1_IntvThankYou_BloodspotIntroLtr_English.pdf Supplementary Document Uploaded 2016-08-03 Available
AttX2_IntroEmailScripts_CellphoneTexts_Spanish.pdf Supplementary Document Uploaded 2016-08-03 Available
AttX1_IntroEmailScripts_CellphoneTexts_English.pdf Supplementary Document Uploaded 2016-08-03 Available
AttW_NBDPS Publications 3_21_16.docx Supplementary Document Uploaded 2016-08-03 Available
AttV2_Rights_Spanish-English.pdf Supplementary Document Uploaded 2016-08-03 Available
AttV1_Rights_AllStates_Graphics_April10_2015.pdf Supplementary Document Uploaded 2016-08-03 Available
AttU2_IntroLetter_Spanish.pdf Supplementary Document Uploaded 2016-08-03 Repair queued
AttU1_IntroLetter_English.pdf Supplementary Document Uploaded 2016-08-03 Available
AttT2_IntroQandA_Spanish.pdf Supplementary Document Uploaded 2016-08-03 Available
AttT1_IntroQandA_Graphics_English.pdf Supplementary Document Uploaded 2016-08-03 Repair queued
AttS_BD_STEPS_Blank_ConfidentialityOathPledges_Jul15_2013.pdf Supplementary Document Uploaded 2016-08-03 Repair queued
AttM_CertificateofConfidentialityExpFeb2019.pdf Supplementary Document Uploaded 2016-08-03 Repair queued
AttL_CollaboratorsList_CBDRP.docx Supplementary Document Uploaded 2016-08-03 Available
AttK_Stillbirth with No Mjor Defect Definition.docx Supplementary Document Uploaded 2016-08-03 Available
AttJ_BD-STEPSBirthDefects_Oct15_2014.pdf Supplementary Document Uploaded 2016-08-03 Available
AttF_ListofBDSTEPSCenters.pdf Supplementary Document Uploaded 2016-08-03 Available
AttE_2087Continuation_ApprovalMemo.docx Supplementary Document Uploaded 2016-08-03 Available
AttC_LetterofAuthorizationDHR2013-18.pdf Supplementary Document Uploaded 2016-08-02 Available
AttB_60-day_Fed_Registry_Notice_Mar17_2016.pdf Supplementary Document Uploaded 2016-08-02 Available
BDSTEPS_SupSta B_052016.docx Supporting Statement B Uploaded 2016-08-02 Available
BDSTEPS_SupSta A.docx Supporting Statement A Uploaded 2016-08-02 Available
AttA_BDPreventionActof1998.pdf Supplementary Document Uploaded 2015-05-28 Available
42 USC 247b_4.pdf Supplementary Document Uploaded 2013-12-02 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
6608 Mother's Questionnaire Form Modified
222820 Intro Phone Script including Consent to Supplemental Stillbirth Other-WORD New
216978 Medical Record Review Instruction Modified
216974 Medical Record Request Form Modified
216968 Occupational Questionnaires Form Modified
187391 Consent for Bloodspot Retrieval Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/29/2020 36 Months From Approved 12/31/2018
6,190 0 4,712
3,034 0 2,291
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 6,190 4,712 0 1,478 0 0
Annual Time Burden (Hours) 3,034 2,291 0 743 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No