ACOG Full Online/Paper Survey

Practice Patterns related to Opioid Use during Pregnancy and Lactation

Documents and Forms

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

Information Collection (IC) Details

IC Title:	ACOG Full Online/Paper Survey	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 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 %

	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

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.