View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Audience: Mothers at Risk for Postpartum Depression
Agency IC Tracking Number:
IC Status:
New
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
Other-Screening Instrument
02_Attachment A_Segmentation Survey Screening Instrument_Final_2_of_10.docx
Yes
Yes
Fillable Fileable
Other-Survey
03_Attachment B_Segmentation Survey_Final_3_of_10.docx
Yes
Yes
Fillable Printable
Other-Survey Screenshots
04_Attachment C_Survey Screenshots_Final_4_of_10.docx
Yes
Yes
Fillable Fileable
Other-Statistical Methods
05_Section B Statistical Methods_Final_5_of_10.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,500
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
2,500
0
2,500
0
0
0
Annual IC Time Burden (Hours)
833
0
833
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement A
01_Supporting Statement A_Final_1_of_10.docx
12/15/2020
Recruitment Flyer
06_Attachment D_Mom Recruitment Flyer for Partners_Final_6_of_10.pdf
12/15/2020
Invitation Postcards
07_Attachment E_Moms Invitation Postcard for Partners_Final_7_of_10.pdf
12/15/2020
Email Language
09_Attachment G_Moms Amerispeak Email Invitation Language_Final_9_of_10.pdf
12/15/2020
Dynata Email Language
10_Attachment H_Moms Dynata Email Language_Final_10_of_10.pdf
12/15/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.