Information Collection

Supplemental CATI about Stillbirth

IC 222820 under ICR 202003-0920-017 · 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⚠️ Notice: This information collection may be referencing outdated material.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: Unchanged

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
	Requested	Previously Approved
Annual Number of Responses for this IC	640	640
Annual IC Time Burden (Hours)	267	267
Annual IC Cost Burden (Dollars)	2,667	2,667

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.