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Father Pre-Natal Interview
Continuation of National Children's Study Vanguard (Pilot) Study Data Collection: Study Visits through 60-Months
OMB: 0925-0593
IC ID: 193569
OMB.report
HHS/NIH
OMB 0925-0593
ICR 201407-0925-005
IC 193569
( )
Documents and Forms
Document Name
Document Type
Form 7.1
Father Pre-Natal Interview
Form and Instruction
7.1 Survey
FatherPreNatalQuestionnaireAdult.docx
Form and Instruction
7.2 Survey
FatherPreNatalQuestionnaireHousehold.docx
Form and Instruction
Attach 9. Informed Consent Form - Fathers and Parental Partners.docx
nformedConsentFormFathersandParentalPartners
IC Document
Attach 13. Multi-Mode Visit Information Script.docx
MultiModeVisitInformationScript
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Father Pre-Natal Interview
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
7.1
Survey
FatherPreNatalQuestionnaireAdult.docx
Yes
Yes
Paper Only
Form and Instruction
7.2
Survey
FatherPreNatalQuestionnaireHousehold.docx
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
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:
317
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
317
0
0
0
0
317
Annual IC Time Burden (Hours)
338
0
0
0
0
338
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
nformedConsentFormFathersandParentalPartners
Attach 9. Informed Consent Form - Fathers and Parental Partners.docx
07/24/2014
MultiModeVisitInformationScript
Attach 13. Multi-Mode Visit Information Script.docx
07/24/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.