Pregnancy Complications History

The Hispanic Community Health Study/ Study of Latinos (HCHS/SOL)(NHLBI)

Documents and Forms

Document Name Document Type
Form 1 Pregnancy Complications History Form and Instruction
1 PCE-Pregnancy Complications Hx - Eng PCE-Pregnancy Complications Hx - Eng mod June 2014.pdf Form and Instruction
PCS-Pregnancy Complications Hx_Span mod 06232014.pdf PCS-Pregnancy Complications Hx - Span IC Document

Information Collection (IC) Details

IC Title:	Pregnancy Complications History	Agency IC Tracking Number:

Is this a Common Form? No		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	1	PCE-Pregnancy Complications Hx - Eng	PCE-Pregnancy Complications Hx - Eng mod June 2014.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,000	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	9,000	9,000
Annual IC Time Burden (Hours)	900	900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
PCS-Pregnancy Complications Hx - Span	PCS-Pregnancy Complications Hx_Span mod 06232014.pdf	06/23/2014

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