PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Community Action Network (CAN) Survey
Modified
225
169
0
Form and Instruction
F
F. CAN Survey_revised.docx
Healthy Start Focus Group Protocol
Modified
180
180
0
Instruction
Healthy Start Site Visit Protocol
Modified
15
90
0
Instruction
National Healthy Start Program Survey (NHSPS)
Modified
100
200
0
Form and Instruction
E
E. NHSPS Survey_revised.docx
Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Demographic Intake
Modified
40675
3254
0
Form and Instruction
B1
3Ps_Demographic Intake Form_revised.doc
Redesigned Preconception, Pregnancy and Parenting (3P's) Information Form: Pregnancy
New
40675
6915
0
Form and Instruction
B2
B2 3Ps_Pregnancy History Form_revised.doc
Redesigned Preconception, Pregnancy and Parenting (3P's) Information Forms 3-6
New
20337
20337
0
Form and Instruction
B3
B3 3Ps_Preconception Form_revised.doc
Form and Instruction
B4
B4 3Ps_Prenatal Form_revised.doc
Form and Instruction
B5
B5 3Ps_Postpartum Form_revised.doc
Form and Instruction
B6
B6 3Ps_Interconception_Parenting Form_revised.doc
Total burden requested under this ICR:
102207
31145
0
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