Information Collection

A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death

IC 237042 under ICR 201806-0920-001 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Recruitment Script and Screener A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death	Form and Instruction
Focus Group Moderator's Guide A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death	Form and Instruction
Recruitment Script and Screener Attachment 2_Focus Group Recruitment Script and Screener_19Jul2019.docx	Form and Instruction
Focus Group Moderator's Guide Attachment 3_Focus Group Moderator Guide_19July2019.docx	Form and Instruction
HMTS~WN4.PDF HMTS Template with Project Overview	IC Document
Attachment 1_Background Information_19Jul2019.docx Additional Project Background and Description	IC Document
Attachment 4_Consent Form for Focus Group Participation_19Jul2019.docx Focus Group Consent Form	IC Document
Attachment 5_Notification Scripts_19July019.docx Script for Notifying Respondents of Eligibility	IC Document
Attachment 6_Recruitment Flyer_19July2019.docx Recruitment Flyer	IC Document
Attachment 7_Creative Concepts_July 2019.pptx Creative Concepts to be Tested	IC Document

IC Title:

A Tailored Communications Campaign to Reduce Pregnancy-related Complications and Death

Agency IC Tracking Number:

0920-19BLV

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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a				No		Paper Only
Form and Instruction	n/a				No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	150	150
Annual IC Time Burden (Hours)	245	245
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HMTS Template with Project Overview		07/22/2019
Additional Project Background and Description		07/22/2019
Focus Group Consent Form		07/22/2019
Script for Notifying Respondents of Eligibility		07/22/2019
Recruitment Flyer		07/22/2019
Creative Concepts to be Tested		07/22/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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