Information Collection

OBGYN Provider Skills Baseline

IC 220392 under ICR 201704-0920-007 · OMB 0920-1129.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1129 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OBGYN Provider Skills Baseline	Form
OBGYN Provider Skills Baseline R2 OBGYN BI-MI Proficiency Rating Scale_Provider Skills Training Baseline.pdf	Form
H2 OBGYN BI-MI Proficiency Rating Scale - Provider Skills Training Baseline.docx OBGYN Provider Skills Baseline - word	IC Document

IC Title:

OBGYN Provider Skills Baseline

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	OBGYN Provider Skills Baseline	R2 OBGYN BI-MI Proficiency Rating Scale_Provider Skills Training Baseline.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OBGYN Provider Skills Baseline - word	H2 OBGYN BI-MI Proficiency Rating Scale - Provider Skills Training Baseline.docx	03/02/2016

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