Information Collection

Stillbirth COVID-19 Sub-Study

IC 257626 under ICR 202405-0920-002 · OMB 0920-0010.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Stillbirth COVID-19 Sub-Study Form and Instruction
Stillbirth COVID-19 Sub-Study Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Interviewed) AttG6.1a_Stillbirth_COVID_Form_final.docx Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Interviewed) AttG6.1a_Stillbirth_COVID_Form_final.docx Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Non-Interviewed) AttG6.2a_Stillbirth_COVID_Form_final.docx Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Non-Interviewed) AttG6.2a_Stillbirth_COVID_Form_final.docx Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Interviewed) Spanish AttG6.1b_Stillbirth_COVID_Form_final.docx Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Interviewed) Spanish AttG6.1b_Stillbirth_COVID_Form_final.docx Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Non-Interviewed) Spa AttG6.2b_Stillbirth_COVID_Form_final.docx Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Non-Interviewed) Spa AttG6.2b_Stillbirth_COVID_Form_final.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Stillbirth COVID-19 Sub-Study	Agency IC Tracking Number:	0920-0010

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Stillbirth COVID-19 Sub-Study Form (Interviewed)	AttG6.1a_Stillbirth_COVID_Form_final.docx	Yes	No	Fillable Fileable
Form and Instruction	n/a	Stillbirth COVID-19 Sub-Study Form (Non-Interviewed)	AttG6.2a_Stillbirth_COVID_Form_final.docx	Yes	No	Fillable Fileable
Form and Instruction	n/a	Stillbirth COVID-19 Sub-Study Form (Interviewed) Spanish	AttG6.1b_Stillbirth_COVID_Form_final.docx	Yes	No	Fillable Fileable
Form and Instruction	n/a	Stillbirth COVID-19 Sub-Study Form (Non-Interviewed) Spanish	AttG6.2b_Stillbirth_COVID_Form_final.docx	Yes	No	Fillable Fileable

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: 157	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	157	157
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	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.