Screening Part A

[NCCDPHP] 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 Screening Part A Form and Instruction
0920-0743 Attachment 4a Screening Part A-English Attachment 4a Screening Part A-English.docx Form and Instruction
0920-0743 Attachment 4b Screening Part A-Spanish Attachment 4b Screening Part A-Spanish.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Screening Part A	Agency IC Tracking Number:	0920-0743

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 and Instruction	0920-0743	Attachment 4a Screening Part A-English	Attachment 4a Screening Part A-English.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0743	Attachment 4b Screening Part A-Spanish	Attachment 4b Screening Part A-Spanish.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 567	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	567	567
Annual IC Time Burden (Hours)	28	28
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.