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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Testing of automated self-response methods for collecting the reduced content version of NCS pregnancy status follow-up contacts
Agency IC Tracking Number:
IC Status:
New
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
1
survey
3. Appendix A - NCS Formative Research Recruiting Questionnaire - Automated self-response.docx
Yes
Yes
Paper Only
Form and Instruction
2
survey
7. Appendix E - Pregnancy Screener for self-response test.docx
Yes
Yes
Paper Only
Form and Instruction
3
survey
8.Appendix F - Consent Form to Receive Text Messages.docx
Yes
Yes
Paper Only
Form and Instruction
4
survey
9. Appendix G - Interactive Voice Response Phone Follow-up Script.docx
Yes
Yes
Paper Only
Form and Instruction
5
survey
11. Appendix I - Web E-mail Follow-up Script.docx
Yes
Yes
Paper Only
Form and Instruction
6
survey
10. Appendix H - Text Message Follow-up Script.docx
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
200
0
0
0
0
0
Annual IC Time Burden (Hours)
100
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
2
2. Automated Self-response Formative Research Cover Memo.docx
07/16/2009
1 Submission of Information Collection - Automated Self-response (2)
1 Submission of Information Collection - Automated Self-response (2).doc
07/16/2009
4
4. Appendix B - Flowchart for 6-week Contact.pdf
07/16/2009
5
5. Appendix C - Flowchart for 12-week Contact.pdf
07/16/2009
6
6. Appendix D - Consent Form for Westat Formative Research Study.docx
07/16/2009
12
12. Appendix J - Westat IRB Expedited Approval.docx
07/16/2009
Terms of Clearance
0925-0590 Terms of Clearance.doc
09/18/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.