Information Collection

Intro Phone Script including Consent to Supplemental Stillbirth

IC 222820 under ICR 201608-0920-002 · OMB 0920-0010.

⚠️ Notice: This information collection may be referencing outdated material.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
AttR1_StillbirthPilot_IntroPhoneScript_English.docx Other-WORD
AttR2_StillbirthPilot_IntroPhoneScript_Spanish.docx Other-Word
Supplemental Stillbirth Computer Assisted Telephone Inte AttI1_BDSTEPS_SB-Suppl Questionnaire_English.docx Form
Supplemental Stillbirth Computer Assisted Telphone Inter AttI2_BDSTEPS_SB-Suppl Questionnaire_Spanish.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Intro Phone Script including Consent to Supplemental Stillbirth	Agency IC Tracking Number:	0920-0010

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			AttR1_StillbirthPilot_IntroPhoneScript_English.docx	No		Paper Only
Other-Word			AttR2_StillbirthPilot_IntroPhoneScript_Spanish.docx	No		Paper Only
Form	N/A	Supplemental Stillbirth Computer Assisted Telephone Interview	AttI1_BDSTEPS_SB-Suppl Questionnaire_English.docx	Yes	Yes	Fillable Printable
Form	N/A	Supplemental Stillbirth Computer Assisted Telphone Interview	AttI2_BDSTEPS_SB-Suppl Questionnaire_Spanish.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

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

Number of Respondents: 710	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	710	710
Annual IC Time Burden (Hours)	296	296
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.