Information Collection

Mother's Consent Script and Computer Assisted Telephone Interview

IC 6608 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⚠️ Notice: This information collection may be referencing outdated material.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
Mother's Consent Script and Computer Assisted Telephone Interview	Form and Instruction
Introductory Phone Script (English) AttQ1_IntroPhoneScripts.docx	Form and Instruction
Introductory Phone Script (Spansih) AttQ2_IntroPhoneScripts_SPAN.docx	Form and Instruction
Computer Assisted Telephone Interview for Mothers (Engli AttF1_BDSTEPS_CATI_V8.0_01292020.docx	Form and Instruction
Computer Assisted Telephone Interview for Mothers (Spani AttF2_BDSTEPS_CATI_V8.0_SPAN_20200205.docx	Form and Instruction

IC Title:

Mother's Consent Script and Computer Assisted Telephone Interview

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	Computer Assisted Telephone Interview for Mothers (Spanish)	AttF2_BDSTEPS_CATI_V8.0_SPAN_20200205.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Computer Assisted Telephone Interview for Mothers (English)	AttF1_BDSTEPS_CATI_V8.0_01292020.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Introductory Phone Script (English)	AttQ1_IntroPhoneScripts.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Introductory Phone Script (Spansih)	AttQ2_IntroPhoneScripts_SPAN.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 3,030

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	3,030	665	2,365
Annual IC Time Burden (Hours)	2,778	1,004	1,774
Annual IC Cost Burden (Dollars)	27,776	27,776	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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