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

Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.