Information Collection

Midwest Utilization of Curriculum Pre-test and Follow-up

IC 204266 under ICR 201209-0920-008 · OMB 0920-0954.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Midwest Utilization of Curriculum Pre-test and Follow-up Midwest Utilization of Curriculum Pre-test and Follow-up	Form
Midwest Utilization of Curriculum Pre-test and Follow-up F8a_screenshots Midwest FASD RTC Utilization of FAS-FASD Curr 3 mo Follow-up - online survey.pdf	Form
F8_Midwest FASD Regional Training Center Utilization of FAS-FASD Curr, Pre-evaluation.doc Midwest Utilization of Curriculum Pre-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 Utilization of Curriculum Pre-test and Follow-up	F8a_screenshots Midwest FASD RTC Utilization of FAS-FASD Curr 3 mo Follow-up - online survey.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: 50

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	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Midwest Utilization of Curriculum Pre-test and Follow-up - Word	F8_Midwest FASD Regional Training Center Utilization of FAS-FASD Curr, Pre-evaluation.doc	09/19/2012

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