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Redesigned Preconception, Pregnancy and Parenting (3P's) Information Forms 3-6
National Healthy Start Evaluation and Quality Assurance
OMB: 0915-0338
IC ID: 223581
OMB.report
HHS/HSA
OMB 0915-0338
ICR 201609-0915-003
IC 223581
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0338 can be found here:
2024-06-20 - No material or nonsubstantive change to a currently approved collection
2024-02-27 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form B3
Redesigned Preconception, Pregnancy and Parenting (3P's) Information Forms 3-6
Form and Instruction
B3 B3 3Ps_Preconception Form_revised.doc
B3. 3Ps_Preconception Form_revised.doc
Form and Instruction
B4 B4 3Ps_Prenatal Form_revised.doc
B4. 3Ps_Prenatal Form_revised.doc
Form and Instruction
B5 B5 3Ps_Postpartum Form_revised.doc
B5. 3Ps_Postpartum Form_revised.doc
Form and Instruction
B6 B6 3Ps_Interconception_Parenting Form_revised.doc
B6. 3Ps_Interconception_Parenting Form_revised.doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Redesigned Preconception, Pregnancy and Parenting (3P's) Information Forms 3-6
Agency IC Tracking Number:
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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
B3
B3 3Ps_Preconception Form_revised.doc
B3. 3Ps_Preconception Form_revised.doc
Yes
Yes
Fillable Fileable
Form and Instruction
B4
B4 3Ps_Prenatal Form_revised.doc
B4. 3Ps_Prenatal Form_revised.doc
Yes
Yes
Fillable Fileable
Form and Instruction
B5
B5 3Ps_Postpartum Form_revised.doc
B5. 3Ps_Postpartum Form_revised.doc
Yes
Yes
Fillable Fileable
Form and Instruction
B6
B6 3Ps_Interconception_Parenting Form_revised.doc
B6. 3Ps_Interconception_Parenting Form_revised.doc
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20,337
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
75 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20,337
0
20,337
0
0
0
Annual IC Time Burden (Hours)
20,337
0
20,337
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.