View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Cognitive testing of maternal health in local jails survey	Agency IC Tracking Number:	BJS

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
Form and Instruction	1121-0339	Understanding Maternal Health in Local Jails	Attachment A - Instrument.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Correctional Activities

Subfunction: Criminal Incarceration

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	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	60	0	60	0	0	0
Annual IC Time Burden (Hours)	115	0	115	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Maternal Health in Local Jails Memo	BJS-SSP_Maternal_Health_Generic Clearance Memo - 05-29-25.docx	06/30/2025
Maternal Health GEN IC template	Generic Clearance IC Template 1121-0339_SSPMaternalHealth.docx	06/30/2025
All SSP Maternal Health Attachments	All SSP Maternal Health Attachments.pdf	07/01/2025
Attachment A - Instrument	Attachment A - Instrument.pdf	07/11/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.