Great Lakes Healthcare Providers Comprehensive Pre-test

Fetal Alcohol Spectrum Disorders Regional Training Centers

Documents and Forms

Document Name Document Type
Great Lakes Healthcare Providers Comprehensive Pre-test Form
Great Lakes Comprehensive Pre-test E10a_screenshots Great Lakes FASD RegionalTraining Center QUALTRICS FASD Com.pdf Form
E10_Great Lakes FASD RegionalTraining Center FASD Comprehensive.docx Great Lakes Comprehensive Pre-test - Word IC Document

Information Collection (IC) Details

IC Title:	Great Lakes Healthcare Providers Comprehensive Pre-test	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	none	Great Lakes Comprehensive Pre-test	E10a_screenshots Great Lakes FASD RegionalTraining Center QUALTRICS FASD Com.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 220	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	220	220
Annual IC Time Burden (Hours)	55	55
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Great Lakes Comprehensive Pre-test - Word	E10_Great Lakes FASD RegionalTraining Center FASD Comprehensive.docx	09/19/2012

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