Information Collection

Mother's Consent Script and Computer Assisted Telephone Interview

IC 6608 under ICR 202103-0920-008 · OMB 0920-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0010 can be found here:

2025-05-01 - No material or nonsubstantive change to a currently approved collection
2024-05-07 - No material or nonsubstantive change to a currently approved collection

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) ATT17_BD2_ENG_IntroPhoneScripts_20190318_wSB supplemental intro_CLEAN_FINAL.docx	Form and Instruction
Introductory Phone Script (English) ATT17_BD2_ENG_IntroPhoneScripts_20190318_wSB supplemental intro_CLEAN_FINAL.docx	Form and Instruction
Introductory Phone Script (Spansih) ATT17_BD2_IntroPhoneScripts_SPAN_20201229_CLEAN.docx	Form and Instruction
Introductory Phone Script (Spansih) ATT17_BD2_IntroPhoneScripts_SPAN_20201229_CLEAN.docx	Form and Instruction
0920-0010 BDSTEPS_CATI_V8.0.3 Att18_BD-STEPSII_CATI_v8_20201108_ForOMB_Clean final.docx	Form and Instruction
0920-0010 BDSTEPS_CATI_V8.0.3 Att18_BD-STEPSII_CATI_v8_20201108_ForOMB_Clean final.docx	Form and Instruction
0920-0010 BDSTEPS_CATI_V8.0.3_SPAN Att18_BD-STEPSII_CATI_v8_SPAN_20210305_CLEAN.docx	Form and Instruction
0920-0010 BDSTEPS_CATI_V8.0.3_SPAN Att18_BD-STEPSII_CATI_v8_SPAN_20210305_CLEAN.docx	Form and Instruction
Att37_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithoutoBD_Eng_08_31_2020_clean_v2.docx Introductory Letter Stillbirth and BD	IC Document
Att37_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithoutoBD_Eng_08_31_2020_clean_v2.docx Introductory Letter Stillbirth and BD	IC Document
Att37_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithoutoBD_SPAN_08312020_Proofread 12-28-20-clean.docx Introductory Letter Stillbirth and BD Spanish	IC Document
Att37_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithoutoBD_SPAN_08312020_Proofread 12-28-20-clean.docx Introductory Letter Stillbirth and BD Spanish	IC Document
Att37A_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithBD Controls_English_08_31_2020_Clean_v2.docx Introductory Letter Stillbirth and BD Controls	IC Document
Att37A_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithBD Controls_English_08_31_2020_Clean_v2.docx Introductory Letter Stillbirth and BD Controls	IC Document
Att37A_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithBD Controls Spanish 08312020_Proofread 12-28-20-Clean.docx Introductory Letter Stillbirth and BD Controls Spanish	IC Document
Att37A_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithBD Controls Spanish 08312020_Proofread 12-28-20-Clean.docx Introductory Letter Stillbirth and BD Controls Spanish	IC Document

Information Collection (IC) Details

View Information Collection (IC)

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	Introductory Phone Script (English)	ATT17_BD2_ENG_IntroPhoneScripts_20190318_wSB supplemental intro_CLEAN_FINAL.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Introductory Phone Script (Spansih)	ATT17_BD2_IntroPhoneScripts_SPAN_20201229_CLEAN.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0010	BDSTEPS_CATI_V8.0.3	Att18_BD-STEPSII_CATI_v8_20201108_ForOMB_Clean final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0010	BDSTEPS_CATI_V8.0.3_SPAN	Att18_BD-STEPSII_CATI_v8_SPAN_20210305_CLEAN.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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	Previously Approved
Annual Number of Responses for this IC	3,030	3,030
Annual IC Time Burden (Hours)	2,778	2,778
Annual IC Cost Burden (Dollars)	27,776	27,776

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Introductory Letter Stillbirth and BD	Att37_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithoutoBD_Eng_08_31_2020_clean_v2.docx	01/21/2021
Introductory Letter Stillbirth and BD Spanish	Att37_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithoutoBD_SPAN_08312020_Proofread 12-28-20-clean.docx	01/21/2021
Introductory Letter Stillbirth and BD Controls	Att37A_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithBD Controls_English_08_31_2020_Clean_v2.docx	01/21/2021
Introductory Letter Stillbirth and BD Controls Spanish	Att37A_BD2_SBSupp_Combined_MainSuppCATI_ IntroductoryLetter_SBwithBD Controls Spanish 08312020_Proofread 12-28-20-Clean.docx	01/21/2021

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