Retrospective Pregnancy Interview

Continuation of National Children's Study Vanguard (Pilot) Study Data Collection: Study Visits through 60-Months

Documents and Forms

Document Name Document Type
Form 45.1 Retrospective Pregnancy Interview Form and Instruction
45.1 Survey RetrospectivePregnancyBirthCohortQuestionnaireAdult.docx Form and Instruction
45.3 Survey RetrospectivePregnancyBirthCohortSAQ.docx Form and Instruction
45.2 Survey RetrospectivePregnancyBirthCohortQuestionnaireHousehold.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Retrospective Pregnancy Interview	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	45.1	Survey	RetrospectivePregnancyBirthCohortQuestionnaireAdult.docx	Yes	Yes	Paper Only
Form and Instruction	45.3	Survey	RetrospectivePregnancyBirthCohortSAQ.docx	Yes	Yes	Paper Only
Form and Instruction	45.2	Survey	RetrospectivePregnancyBirthCohortQuestionnaireHousehold.docx	Yes	Yes	Paper Only

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 422	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	422	422
Annual IC Time Burden (Hours)	331	331
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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