Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Birth Activities-Mother and Children Removed 0 0 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 Removed 0 0 0 Form and Instruction C.10.5
Community Leaders Removed 0 0 0 Form and Instruction C.9.4
Enhanced Household: Birth Visit Interview New 516 206 0 Form and Instruction 8
Enhanced Household: Household Enumeration Script Modified 120000 39600 0 Form and Instruction 1
Enhanced Household: Neighbor Report New 12000 600 0 Form 10
Enhanced Household: Pre-pregnancy Interview New 211 158 0 Form and Instruction 4
Enhanced Household: Pregnancy Probability Group Follow Up Script New 1266 127 0 Form and Instruction 5.1
Form and Instruction 5.2
Enhanced Household: Pregnancy Screening Modified 51198 21503 0 Form and Instruction 2
Enhanced Household: Pregnancy Visit 1 Interview New 986 986 0 Form and Instruction 6
Enhanced Household: Pregnancy Visit 2 Interview New 986 740 0 Form and Instruction 7
Enhanced Household: Women's Informed Consent Form New 2586 1733 0 Form and Instruction 3.1
Fathers Removed 0 0 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 Removed 0 0 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 Removed 0 0 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 Removed 0 0 0 Form and Instruction A.1.2.b
Low Probability Women Removed 0 0 0 Form and Instruction A.1.2.b
Moderate Probability Women Removed 0 0 0 Form and Instruction A.1.2.b
Postnatal Activities - Mother and Children Removed 0 0 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 Removed 0 0 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
Provider-Based: Address Look-Up New 7500 750 0 Instruction
Provider-Based: Birth Visit Interview New 299 120 0 Form and Instruction 8
Provider-Based: Pre-Pregnancy Visit New 123 92 0 Form and Instruction 4
Provider-Based: Pregnancy Probability Group Follow Up Script New 738 74 0 Form and Instruction 5.1
Form and Instruction 5.2
Provider-Based: Pregnancy Screening New 1500 630 0 Form and Instruction 2.3
Provider-Based: Pregnancy Visit 1 Interview New 572 572 0 Form and Instruction 6
Provider-Based: Pregnancy Visit 2 Interview New 572 429 0 Form and Instruction 7
Provider-Based: Women's Informed Consent Form New 1500 1005 0 Form and Instruction 3.1
Two Tier (High): Pre-Pregnancy Interview New 761 571 0 Form and Instruction 4
Two Tier (High): Pregnancy Probability Group Follow Up Script New 4566 457 0 Form and Instruction 5.1
Form and Instruction 5.2
Two Tier (High): Pregnancy Screening New 15840 6653 0 Form and Instruction 2
Two Tier (High): Pregnancy Visit 1 Interview New 3552 3552 0 Form and Instruction 6
Two Tier (High): Pregnancy Visit 2 Interview New 3552 2664 0 Form and Instruction 7
Two Tier (High): Women's Informed Consent Form New 9504 6368 0 Form and Instruction 3.1
Two Tier (Low): Low-Intensity CATI Pregnancy Screener New 48000 16800 0 Form and Instruction 2.2
Two Tier (Low): Low-Intensity CATI Questionnaire (Age-Eligible Women) New 10057 5029 0 Form and Instruction 9
Two Tier (Low): Low-Intensity CATI Questionnaire (Birth-Related Activities) New 166 83 0 Form and Instruction 9
Two Tier (Low): Low-Intensity CATI Questionnaire (Pregnancy Activities) New 518 259 0 Form and Instruction 9
Two Tier (Low): Low-Intensity Consent Script New 28800 9504 0 Form and Instruction 3.2
Form and Instruction 3.3
Two Tier (Low): Pregnancy Probability Group Follow Up Script New 60342 6034 0 Form and Instruction 5.2
Form and Instruction 5.1
Two-Tier (High): Birth Visit Interview New 1857 743 0 Form and Instruction 8
Total burden requested under this ICR: 390068 128042 0  
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