Information Collection

Supplemental CATI about Stillbirth

IC 222820 under ICR 201908-0920-005 · OMB 0920-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0010 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Supplemental CATI about Stillbirth	Form and Instruction
Introductory Phone Script for the Interview about Stillb AttV1_SB-Suppl_IntroPhoneScript.docx	Form and Instruction
Introductory Phone Script for the Interview about Stillb AttV2_SB-Suppl_IntroPhoneScript_SPAN.docx	Form and Instruction
Computer Assisted Phone Interview about Stillbirth (Engl AttJ1_BDSTEPS_SB-Suppl Quest.docx	Form and Instruction
Computer Assisted Phone Interview about Stillbirth (Span AttJ2_BDSTEPS_SB-Suppl Quest_SPAN.docx	Form and Instruction
AttO1_SB-Suppl_IntroLetter.docx Introductory Letter for the Supplemental Interview about Stillbirth (English)	IC Document
AttO2_SB-Suppl_IntroLetter_SPAN.docx Introductory Letter for the Supplemental Interview about Stillbirth (Spanish)	IC Document
AttP1_SB-Suppl_IntvThankYou.doc Thankyou Letter for the Supplemental Interview about Stillbirth (English)	IC Document
AttP2_SB-Suppl_IntvThankYou_SPAN.doc Thankyou Letter for the Supplemental Interview about Stillbirth (Spanish)	IC Document

IC Title:

Supplemental CATI about Stillbirth

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Introductory Phone Script for the Interview about Stillborth (English)	AttV1_SB-Suppl_IntroPhoneScript.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Introductory Phone Script for the Interview about Stillborth (Spanish)	AttV2_SB-Suppl_IntroPhoneScript_SPAN.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Computer Assisted Phone Interview about Stillbirth (English)	AttJ1_BDSTEPS_SB-Suppl Quest.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Computer Assisted Phone Interview about Stillbirth (Spanish)	AttJ2_BDSTEPS_SB-Suppl Quest_SPAN.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 640

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	640	-70	710
Annual IC Time Burden (Hours)	267	-29	296
Annual IC Cost Burden (Dollars)	2,667	2,667	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Introductory Letter for the Supplemental Interview about Stillbirth (English)	AttO1_SB-Suppl_IntroLetter.docx	08/26/2019
Introductory Letter for the Supplemental Interview about Stillbirth (Spanish)	AttO2_SB-Suppl_IntroLetter_SPAN.docx	08/26/2019
Thankyou Letter for the Supplemental Interview about Stillbirth (English)	AttP1_SB-Suppl_IntvThankYou.doc	08/26/2019
Thankyou Letter for the Supplemental Interview about Stillbirth (Spanish)	AttP2_SB-Suppl_IntvThankYou_SPAN.doc	08/26/2019

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