Epidemiologist - Pregnancy Module

SARS-CoV-2 Epidemiologic Data Collections

Documents and Forms

Document Name Document Type
Epidemiologist - Pregnancy Module Form and Instruction
Pregnancy Module 11. Pregnancy Module Supplement_Instrument_OMB.pdf Form and Instruction
0920-1297 Pregnancy Module - Pregnant Women/Neonate Form) REVISED COVID-19_Pregnancy_Module_V2.0_Final 16-Sep-2020_Updated.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Epidemiologist - Pregnancy Module	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	NA	Pregnancy Module	11. Pregnancy Module Supplement_Instrument_OMB.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1297	Pregnancy Module - Pregnant Women/Neonate Form) REVISED 16SEP2020	COVID-19_Pregnancy_Module_V2.0_Final 16-Sep-2020_Updated.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 92812

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	29,250	9,250	20,000
Annual IC Time Burden (Hours)	14,625	-375	15,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.