Information Collection

Fetal Alcohol Spectrum Disorder (FASD) Center for Excellence

IC 188132 under ICR 200710-0930-001 · OMB 0930-0197.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0197 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Forms Fetal Alcohol Spectrum Disorder (FASD) Center for Excellence	Form and Instruction
Forms Attachments A-J ATTACHMENT A-J.doc	Form and Instruction
FASD- Training &TA - Supporting Statement.doc Supporting Statement	IC Document
OMBTransLet5-2009.wpd Justification Letter	IC Document

IC Title:

Fetal Alcohol Spectrum Disorder (FASD) Center for Excellence

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Forms	Attachments A-J	ATTACHMENT A-J.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,405

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	6,685	0	0	0	0	0
Annual IC Time Burden (Hours)	601	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	FASD- Training &TA - Supporting Statement.doc	02/18/2009
Justification Letter	OMBTransLet5-2009.wpd	02/18/2009

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