Information Collection

Epidemiologist - Pregnancy Module

IC 241645 under ICR 202009-0920-012 · OMB 0920-1297.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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	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 %

table that charts list of burden
	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

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.