CDC mPINC Hospital Survey

Assessment & Monitoring of Breastfeeding-Related Maternity Care Practices in Intrapartum Care Facilities in the United States and Territories

Documents and Forms

Document Name Document Type
Form 0920-0743 CDC mPINC Hospital Survey Form
0920-0743 CDC mPINC Hospital Survey (Maternity Practices in Infant Attachment 5c mPINC Hospital Survey.docx Form
0920-0743 CDC mPINC Hospital Survey (Maternity Practices in Infant Attachment 5c mPINC Hospital Survey_rev 2.2.2022.docx Form
Attachment 3d Screenshots mPINC 2022 Survey.docx Att 3d Screenshots mPINC 2022 IC Document
Attachment 3d Screenshots mPINC 2022 Survey.docx Att 3d Screenshots mPINC 2022 IC Document
Attachment 5a Survey Cover Letter paper.docx Att 5a Sirveu Cover Letter (paper) IC Document
Attachment 5a Survey Cover Letter paper.docx Att 5a Sirveu Cover Letter (paper) IC Document
Attachment 5b Survey Cover Letter email.docx Att 5b Survey Cover Letter (email) IC Document
Attachment 5b Survey Cover Letter email.docx Att 5b Survey Cover Letter (email) IC Document
Attachment 5e Reminder (e-mail).docx Att 5e_Reminder (email) IC Document
Attachment 5e Reminder (e-mail).docx Att 5e_Reminder (email) IC Document
bulletins_b00-02.pdf OMB Bulletin No. 00-22 IC Document

Information Collection (IC) Details

IC Title:	CDC mPINC Hospital Survey	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	0920-0743	CDC mPINC Hospital Survey (Maternity Practices in Infant Nutrition and Care 2022)	Attachment 5c mPINC Hospital Survey_rev 2.2.2022.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,293	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,293	-128	1,421
Annual IC Time Burden (Hours)	647	-64	711
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att 3d Screenshots mPINC 2022	Attachment 3d Screenshots mPINC 2022 Survey.docx	09/29/2021
Att 5a Sirveu Cover Letter (paper)	Attachment 5a Survey Cover Letter paper.docx	09/29/2021
Att 5b Survey Cover Letter (email)	Attachment 5b Survey Cover Letter email.docx	09/29/2021
Att 5e_Reminder (email)	Attachment 5e Reminder (e-mail).docx	09/29/2021
OMB Bulletin No. 00-22	bulletins_b00-02.pdf	03/15/2022

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