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

National Healthy Start Evaluation and Quality Assurance

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.