Information Collection List

IC Title	Status	Responses	Hours	Dollars	Document Type	Form No.
Consent for Bloodspot Retrieval	Modified	1375	344	0	Form and Instruction	none
					Form and Instruction	none
					Form and Instruction	none
					Form and Instruction	none
Intro Phone Script including Consent to Supplemental Stillbirth	New	710	296	0	Other-WORD
					Other-Word
					Form	N/A
					Form	N/A
Medical Record Request	Modified	475	119	0	Form	none
Medical Record Request	Modified	475	119	0	Form	none
Medical Record Review	Modified	475	238	0	Instruction
Mother's Questionnaire	Modified	2365	1774	0	Form	none
Mother's Questionnaire	Modified	2365	1774	0	Form	none
Occupational Questionnaires	Modified	790	263	0	Form	none
					Form	none
					Form	none
					Form	none
					Form	none
					Form	none
					Form	none
					Form	none
Total burden requested under this ICR:		6190	3034	0
To view an IC, click on IC Title