Information Collection

ASD - POST ENROLLMENT _F/U Phone Call / Pregnancy Ref Form- (Mother)

IC 224013 under ICR 202102-0920-008 · OMB 0920-1171.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 7.a. Pregnancy Reference Form Script SEED 3_9-19-16.doc	Other-WORD
Attachment 7.a. Pregnancy Reference Form Script SEED 3_9-19-16.doc	Other-WORD
Attachment 7.b. Pregnancy Reference Form SEED 3_9_19_16.docx	Other-WORD
Attachment 7.b. Pregnancy Reference Form SEED 3_9_19_16.docx	Other-WORD
Att 21.d. Follow-up Call Items Checklist SEED 3_3-7-17.docx Att 21d_Follow-up Call Checklist	IC Document
Att 21.d. Follow-up Call Items Checklist SEED 3_3-7-17.docx Att 21d_Follow-up Call Checklist	IC Document

IC Title:

Agency IC Tracking Number:

16PA

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Attachment 7.a. Pregnancy Reference Form Script SEED 3_9-19-16.doc		Yes	No	Fillable Printable
Other-WORD			Attachment 7.b. Pregnancy Reference Form SEED 3_9_19_16.docx		No		Fillable Printable

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: 422

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	Previously Approved
Annual Number of Responses for this IC	422	422
Annual IC Time Burden (Hours)	106	106
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 21d_Follow-up Call Checklist	Att 21.d. Follow-up Call Items Checklist SEED 3_3-7-17.docx	03/16/2017

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