Great Lakes Healthcare Providers ID and Treatment Pre-test

Fetal Alcohol Spectrum Disorders Regional Training Centers

OMB: 0920-0954

IC ID: 204246

Information Collection (IC) Details

View Information Collection (IC)

Great Lakes Healthcare Providers ID and Treatment Pre-test
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none ID and Treatment Pre-test E7a_screenshots Great Lakes FASD RTCQUALTRICS Identification and Treatment.pdf Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

270 0
   
Individuals or Households
 
   50 %

  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 270 0 270 0 0 0
Annual IC Time Burden (Hours) 36 0 36 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
ID and Treatment Pre-test - Word E7_Great Lakes FASD RegionalTraining Center Identification and.docx 09/19/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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