Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Birth Activities-Mother and Children	New	1824	693	0	Form and Instruction	A.3.2
					Form and Instruction	A.2.1.h
					Form and Instruction	A.2.3.L5
					Form and Instruction	A.1.1.a
					Form and Instruction	A.1.1.c
Child Care Providers	New	120	120	0	Form and Instruction	C.10.5
Community Leaders	New	165	8	0	Form and Instruction	C.9.4
Eligibility Screening	New	14954	1196	0	Form and Instruction	A.1.1.b
Fathers	New	1908	1374	0	Form and Instruction	A.2.3.f
					Form and Instruction	A.1.3.b
					Form and Instruction	A.2.2.a
					Form and Instruction	A.2.2.b
					Form and Instruction	A.2.2.c
					Form and Instruction	A.2.2.d
					Form and Instruction	A.2.2.e
					Form and Instruction	A.2.3.b3
					Form and Instruction	A.2.3.f
					Form and Instruction	A.2.3.i
					Form and Instruction	A.2.3.i
					Form and Instruction	A.2.3.j1
					Form and Instruction	A.2.3.j2
					Form and Instruction	A.2.3.j3
					Form and Instruction	A.2.3.L3
					Form and Instruction	A.2.3.m1
					Form and Instruction	A.3.1
					Form and Instruction	A.3.3
Health Care Providers	New	165	8	0	Form and Instruction	C.9.3
					Form and Instruction	A.2.1
					Form and Instruction	A.2.3
High Probability Women w/Pre-pregnancy Visit	New	646	601	0	Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
High Probability Women w/o Pre-pregnancy Visit	New	2504	200	0	Form and Instruction	A.1.2.b
Household Enumeration	New	25381	2030	0	Form and Instruction	A.1.1.a2
					Form and Instruction	A.1.1.a1
					Form and Instruction	A.1.1.c
					Form and Instruction	A.1.1.a2
					Form and Instruction	A.1.1.c
Low Probability Women	New	1181	94	0	Form and Instruction	A.1.2.b
Moderate Probability Women	New	5500	440	0	Form and Instruction	A.1.2.b
Postnatal Activities - Mother and Children	New	3572	2893	0	Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
Pregnancy Activities	New	6678	4140	0	Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
					Other-Results Letter
					Form and Instruction	1
					Form and Instruction	1
					Form and Instruction	1
Total burden requested under this ICR:		64598	13797	0
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