Information Collection

Pathways: Qualitative Interviews with Post-Partum Women Associated with Congenital Syphilis Cases (Case Mothers)

IC 235472 under ICR 201808-0920-023 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0840 Pathways: Qualitative Interviews with Post-Partum Women Associated with Congenital Syphilis Cases (Case Mothers)	Form and Instruction
0920-0840 Recruitment Script Att 3a-Recruitment Script.docx	Form and Instruction
0920-0840 Interview Scheduling Script Att 3c-Interview Scheduling Script ICRO edits.docx	Form and Instruction
0920-0840 Interview Guide Att 5a-Interview Guide ICRO edits_clean.docx	Form and Instruction
1 Generic Eligibility Request 0920-0840 updated.doc Generic Elibility Request	IC Document
Att 1-PHS Act Legislation.pdf PHS Act Legislation	IC Document
Att 2-60 Day FRN.pdf 60 Day FRN	IC Document
Att 3b-Recruitment Verification Form ICRO edits.docx Recruitment Verification Form	IC Document
Att 4-Consent Form ICRO edits.docx Consent Form	IC Document
Att 6-IRB Letter of Approval.doc IRB Letter of Approval	IC Document
SSA Pathways_03222019_clean.docx SSA	IC Document
SSB Pathways.docx SSB	IC Document
Att 7-PIA_18AVE approved 12-11-2018.pdf PIA	IC Document

IC Title:

Pathways: Qualitative Interviews with Post-Partum Women Associated with Congenital Syphilis Cases (Case Mothers)

Agency IC Tracking Number:

0920-0840-18AVE

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	Available Electronically?	Electronic Capability
Form and Instruction	0920-0840	Recruitment Script	Att 3a-Recruitment Script.docx	No	Fillable Fileable
Form and Instruction	0920-0840	Interview Scheduling Script	Att 3c-Interview Scheduling Script ICRO edits.docx	No	Fillable Fileable
Form and Instruction	0920-0840	Interview Guide	Att 5a-Interview Guide ICRO edits_clean.docx	No	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 420

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	420	420
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Elibility Request	1 Generic Eligibility Request 0920-0840 updated.doc	03/26/2019
PHS Act Legislation	Att 1-PHS Act Legislation.pdf	03/26/2019
60 Day FRN	Att 2-60 Day FRN.pdf	03/26/2019
Recruitment Verification Form	Att 3b-Recruitment Verification Form ICRO edits.docx	03/26/2019
Consent Form	Att 4-Consent Form ICRO edits.docx	03/26/2019
IRB Letter of Approval	Att 6-IRB Letter of Approval.doc	03/26/2019
SSA	SSA Pathways_03222019_clean.docx	03/26/2019
SSB	SSB Pathways.docx	03/26/2019
PIA	Att 7-PIA_18AVE approved 12-11-2018.pdf	03/26/2019

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