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Att 6c_MPINC Facility Survey
Assessment & Monitoring of Breastfeeding-Related Maternity Care Practices in Intrapartum Care Facilities in the United States and Territories
OMB: 0920-0743
IC ID: 179025
OMB.report
HHS/CDC
OMB 0920-0743
ICR 201810-0920-001
IC 179025
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0743 can be found here:
2021-10-21 - Revision of a currently approved collection
2020-02-14 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-0743
Att 6c_MPINC Facility Survey
Form and Instruction
Att. 6c mPINC Facility Survey.doc
Other-WORD
0920-0743 CDC mPINC Hospital Suvey (Maternity Practices in Infant
Att. 3m Screenshots mPINC Survey.docx
Form and Instruction
Att. 6a Survey Cover Letter paper.docx
Att 6a_Survey Cover Letter
IC Document
Att. 6b Survey Cover Letter email.docx
Att 6b_Survey Cover Letter (E-mail)
IC Document
Att. 6d Reminder (paper).docx
Att 6d_Reminder
IC Document
Att. 6e Reminder (e-mail).docx
Att 6e_Reminder (e-mail)
IC Document
Att. 6f Non-Responder Follow-Up.docx
Att 6f_Non-Responder Follow-Up
IC Document
Att. 6g Non-Responder Script.docx
Att 6g_Non-Responder Script
IC Document
Att. 6h Returned Surveys paper.docx
Att 6h_Returned Surveys
IC Document
Att. 6i Returned Surveys e-mail.docx
Att 6i_Returned Surveys (E-mail)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att 6c_MPINC Facility Survey
Agency IC Tracking Number:
0920-0743
Is this a Common Form?
No
IC Status:
Unchanged
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
0920-0743
CDC mPINC Hospital Suvey (Maternity Practices in Infant Nutrition and Care 2018)
Att. 3m Screenshots mPINC Survey.docx
Yes
Yes
Fillable Fileable
Other-WORD
Att. 6c mPINC Facility Survey.doc
No
Paper Only
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:
1,421
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
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
1,421
0
1,421
0
0
0
Annual IC Time Burden (Hours)
711
0
711
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 6a_Survey Cover Letter
Att. 6a Survey Cover Letter paper.docx
08/14/2018
Att 6b_Survey Cover Letter (E-mail)
Att. 6b Survey Cover Letter email.docx
08/14/2018
Att 6d_Reminder
Att. 6d Reminder (paper).docx
08/14/2018
Att 6e_Reminder (e-mail)
Att. 6e Reminder (e-mail).docx
08/14/2018
Att 6f_Non-Responder Follow-Up
Att. 6f Non-Responder Follow-Up.docx
08/14/2018
Att 6g_Non-Responder Script
Att. 6g Non-Responder Script.docx
08/14/2018
Att 6h_Returned Surveys
Att. 6h Returned Surveys paper.docx
08/14/2018
Att 6i_Returned Surveys (E-mail)
Att. 6i Returned Surveys e-mail.docx
08/14/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.