Information Collection

ACOG Full Online/Paper Survey

IC 223394 under ICR 201609-0920-001 · OMB 0920-1168.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ACOG Full Online/Paper Survey	Form and Instruction
ACOG Practice Patterns related to Opioid Use during Preg 8 Att4a_Full Online Survey.pdf	Form and Instruction
ACOG Practice Patterns related to Opioid Use during Preg 9 Att4b_Full Paper Survey.docx	Form and Instruction

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 and Instruction	NA	ACOG Practice Patterns related to Opioid Use during Pregnancy and Lactation - FULL ONLINE	8 Att4a_Full Online Survey.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	ACOG Practice Patterns related to Opioid Use during Pregnancy and Lactation - FULL PAPER	9 Att4b_Full Paper Survey.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 420

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	420	420
Annual IC Time Burden (Hours)	105	105
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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