Information Collection

Prenatal Form

IC 211288 under ICR 202503-0915-001 · OMB 0915-0338.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Prenatal Form	Form and Instruction
Form 3 Prenatal Form Prenatal Form	Form and Instruction
Form 3_Revised Prenatal Form (Revised) Prenatal Form	Form and Instruction
3 Prenatal Form B2 - Prenatal Form.docx	Form and Instruction
3 Prenatal Form B2 - Prenatal Form.docx	Form and Instruction
3_Revised Prenatal Form (Revised) Attachment 1 - Prenatal Form.docx	Form and Instruction
3_Revised Prenatal Form (Revised) Attachment 1 - Prenatal Form.docx	Form and Instruction

IC Title:

Prenatal Form

Agency IC Tracking Number:

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
Form and Instruction	3				Yes	Yes	Fillable Fileable
Form and Instruction	3_Revised				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30,300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30,300	30,300
Annual IC Time Burden (Hours)	6,060	6,060
Annual IC Cost Burden (Dollars)	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.

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