View Information Collection (IC)

View Information Collection (IC)

IC Title:	Two Tier (High): Pre-Pregnancy Interview	Agency IC Tracking Number:

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	4	Survey	Pre-pregnancy interview July Launch 20100607a.docx		Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 761	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	761	0	0	0	0	761
Annual IC Time Burden (Hours)	571	0	0	0	0	571
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Pre--pregnancy interview July Launch VIS 20100615	Pre--pregnancy interview July Launch VIS 20100615.pdf	06/15/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.