Beta Test of PregSource™ Crowd-Sourcing to Understand Pregnancy

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0643 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Beta Test of PregSource™ Crowd-Sourcing to Understand Pregnancy Form
1 PregSourceBeta Test Survey 0925-0643_Substudy_PregSourceBetaTest_Survey.pdf Form
0925-0643_Substudy_PregSourceBetaTest_ClearanceRequest.doc PregSource Beta Test Clearance request IC Document
0925-0643_Substudy_PregSourceBetaTest_Emails.docx PregSource Beta Test Emails IC Document

Information Collection (IC) Details

IC Title:	Beta Test of PregSource™ Crowd-Sourcing to Understand Pregnancy	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
Form	1	PregSourceBeta Test Survey	0925-0643_Substudy_PregSourceBetaTest_Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PregSource Beta Test Clearance request	0925-0643_Substudy_PregSourceBetaTest_ClearanceRequest.doc	11/07/2016
PregSource Beta Test Emails	0925-0643_Substudy_PregSourceBetaTest_Emails.docx	11/07/2016

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