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⚠️ Notice: This information collection may be referencing outdated material.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
Introductory Phone Script for the Interview about Stillborth (English) Supplemental CATI about Stillbirth	Form and Instruction
Introductory Phone Script for the Interview about Stillborth (Spanish) Supplemental CATI about Stillbirth	Form and Instruction
Computer Assisted Phone Interview about Stillbirth (English) Supplemental CATI about Stillbirth	Form and Instruction
Computer Assisted Phone Interview about Stillbirth (Spanish) 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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	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)		08/26/2019
Introductory Letter for the Supplemental Interview about Stillbirth (Spanish)		08/26/2019
Thankyou Letter for the Supplemental Interview about Stillbirth (English)		08/26/2019
Thankyou Letter for the Supplemental Interview about Stillbirth (Spanish)		08/26/2019

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].