Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Enhanced Household: Birth Visit Interview Modified 516 206 0 Form and Instruction 8 Survey
Enhanced Household: Household Enumeration Script Modified 120000 39600 0 Form and Instruction 1 Survey
Enhanced Household: Neighbor Report Modified 12000 600 0 Form 10 Form
Enhanced Household: Pre-pregnancy Interview Modified 211 158 0 Form and Instruction 4 Survey
Enhanced Household: Pregnancy Probability Group Follow Up Script Modified 1266 127 0 Form and Instruction 5.1 Survey
Form and Instruction 5.2 Survey
Enhanced Household: Pregnancy Screening Modified 51198 21503 0 Form and Instruction 2 Survey
Enhanced Household: Pregnancy Visit 1 Interview Modified 986 986 0 Form and Instruction 6 Survey
Enhanced Household: Pregnancy Visit 2 Interview Modified 986 740 0 Form and Instruction 7 Survey
Enhanced Household: Women's Informed Consent Form Modified 2586 1733 0 Form and Instruction 3.1 Consent
Provider-Based: Address Look-Up Modified 7500 750 0 Instruction
Provider-Based: Birth Visit Interview Modified 299 120 0 Form and Instruction 8 Survey
Provider-Based: Pre-Pregnancy Visit Modified 123 92 0 Form and Instruction 4 Survey
Provider-Based: Pregnancy Probability Group Follow Up Script Modified 738 74 0 Form and Instruction 5.1 Survey
Form and Instruction 5.2 Survey
Provider-Based: Pregnancy Screening Modified 1500 630 0 Form and Instruction 2.3 Survey
Provider-Based: Pregnancy Visit 1 Interview Modified 572 572 0 Form and Instruction 6 Survey
Provider-Based: Pregnancy Visit 2 Interview Modified 572 429 0 Form and Instruction 7 Survey
Provider-Based: Women's Informed Consent Form Modified 1500 1005 0 Form and Instruction 3.1 Consent
Two Tier (High): Pre-Pregnancy Interview Modified 761 571 0 Form and Instruction 4 Survey
Two Tier (High): Pregnancy Probability Group Follow Up Script Modified 4566 457 0 Form and Instruction 5.1 Survey
Form and Instruction 5.2 Survey
Two Tier (High): Pregnancy Screening Modified 15840 6653 0 Form and Instruction 2 Survey
Two Tier (High): Pregnancy Visit 1 Interview Modified 3552 3552 0 Form and Instruction 6 Survey
Two Tier (High): Pregnancy Visit 2 Interview Modified 3552 2664 0 Form and Instruction 7 Survey
Two Tier (High): Women's Informed Consent Form Modified 9504 6368 0 Form and Instruction 3.1 Consent
Two Tier (Low): Low-Intensity CATI Pregnancy Screener Modified 48000 16800 0 Form and Instruction 2.2 Survey
Two Tier (Low): Low-Intensity CATI Questionnaire (Age-Eligible Women) Modified 10057 5029 0 Form and Instruction 9 Survey
Two Tier (Low): Low-Intensity CATI Questionnaire (Birth-Related Activities) Modified 166 83 0 Form and Instruction 9 Survey
Two Tier (Low): Low-Intensity CATI Questionnaire (Pregnancy Activities) Modified 518 259 0 Form and Instruction 9 Survey
Two Tier (Low): Low-Intensity Consent Script Modified 28800 9504 0 Form and Instruction 3.2 Consent
Form and Instruction 3.3 Consent
Two Tier (Low): Pregnancy Probability Group Follow Up Script Modified 60342 6034 0 Form and Instruction 5.2 Survey
Form and Instruction 5.1 Survey
Two-Tier (High): Birth Visit Interview Modified 1857 743 0 Form and Instruction 8 Survey
Total burden requested under this ICR: 390068 128042 0  
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