Information Collection

Pregnant Women - Ages and Stages: 12 and 24 Month Questionnaire

IC 229181 under ICR 201710-0920-013 · OMB 0920-1190.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1190 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Pregnant Women - Ages and Stages: 12 and 24 Month Questionnaire	Form and Instruction
Ages and Stages Questionnaire - 12 month English Att B11_Ages and Stages_12_Months.pdf	Form and Instruction
Ages and Stages Questionnaire - 12 month Spanish Att C11_Ages and Stages_12_Months_spanish.pdf	Form and Instruction
Ages and Stages Questionnaire - 24 month English Att B13_Ages and Stages_24_Months.pdf	Form and Instruction
Ages and Stages Questionnaire - 24 month Spanish Att C13_Ages and Stages-24_Months_Spanish.pdf	Form and Instruction

IC Title:

Pregnant Women - Ages and Stages: 12 and 24 Month Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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?	Electronic Capability
Form and Instruction	NA	Ages and Stages Questionnaire - 12 month English	Att B11_Ages and Stages_12_Months.pdf	NA	No	Paper Only
Form and Instruction	NA	Ages and Stages Questionnaire - 12 month Spanish	Att C11_Ages and Stages_12_Months_spanish.pdf	NA	No	Paper Only
Form and Instruction	NA	Ages and Stages Questionnaire - 24 month English	Att B13_Ages and Stages_24_Months.pdf	NA	No	Paper Only
Form and Instruction	NA	Ages and Stages Questionnaire - 24 month Spanish	Att C13_Ages and Stages-24_Months_Spanish.pdf	NA	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0113 - Epidemic Investigation Case Records System

FR Citation: 51 FR 42466

Number of Respondents: 900

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	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.