ACOG - Short Introduction and Survey

Practice Patterns related to Opioid Use during Pregnancy and Lactation

Documents and Forms

Document Name Document Type
ACOG - Short Introduction and Survey Form and Instruction
ACOG Practice Patterns related to Opioid Use during Preg 11 Att6 Short Introduction and Survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	ACOG - Short Introduction and 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 - SHORT INTRODUCTION and SURVEY	11 Att6 Short Introduction and 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: 180	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	15	15
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.