Information Collection

Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Demographic Intake

IC 211288 under ICR 201609-0915-003 · OMB 0915-0338.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0338 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form B1 Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Demographic Intake	Form and Instruction
B1 3Ps_Demographic Intake Form_revised.doc B1. 3Ps_Demographic Intake Form_revised.doc	Form and Instruction

IC Title:

Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Demographic Intake

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 and Instruction	B1	3Ps_Demographic Intake Form_revised.doc	B1. 3Ps_Demographic Intake Form_revised.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40,675

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	40,675	0	40,675
Annual IC Time Burden (Hours)	3,254	-17,084	20,338
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.