Information Collection

Stillbirth COVID-19 Sub-Study

IC 257626 under ICR 202504-0920-004 · OMB 0920-0010.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Stillbirth COVID-19 Sub-Study	Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Interviewed) Stillbirth COVID-19 Sub-Study	Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Non-Interviewed) Stillbirth COVID-19 Sub-Study	Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Interviewed) Spanish Stillbirth COVID-19 Sub-Study	Form and Instruction
Stillbirth COVID-19 Sub-Study Form (Non-Interviewed) Spanish 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

IC Title:

Agency IC Tracking Number:

0920-0010

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Yes	No	Fillable Fileable
Form and Instruction	n/a	Yes	No	Fillable Fileable
Form and Instruction	n/a	Yes	No	Fillable Fileable
Form and Instruction	n/a	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 %

table that charts list of burden
	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

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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