Information Collection

Midwest Academic Knowledge Post-test and Follow-up

IC 204260 under ICR 201209-0920-008 · OMB 0920-0954.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Midwest Academic Knowledge Post-test and Follow-up	Form
Midwest Academic Knowledge Post-test and Follow-up F2a_ screenshots Midwest FASD Regional Training Center Knowledge Assessment 3 mo FU_online (0905).pdf	Form
F2_Midwest FASD Regional Training Center Knowledge Post-Test.doc Midwest Academic Knowledge Post-test and Follow-up - Word	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	none	Midwest Academic Knowledge Post-test and Follow-up	F2a_ screenshots Midwest FASD Regional Training Center Knowledge Assessment 3 mo FU_online (0905).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: 1,080

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,160	2,160
Annual IC Time Burden (Hours)	252	252
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Midwest Academic Knowledge Post-test and Follow-up - Word	F2_Midwest FASD Regional Training Center Knowledge Post-Test.doc	09/19/2012

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