AAP 6 Month Follow-up Evaluation Survey

Improving Fetal Alcohol Spectrum Disorders Prevention and Practice through Practice and Implementation Centers and National Partnerships

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
AAP 6 Month Follow-up Evaluation Survey Form
AAP 6 Month Follow-up Survey AAP Six Month Followup Training Evaluation Survey.pdf Form
AAP Six Month Follow Up Evaluation Survey_Edited V3.docx AAP 6 Month Follow-up Survey - word IC Document

Information Collection (IC) Details

IC Title:	AAP 6 Month Follow-up Evaluation Survey	Agency IC Tracking Number:	17ADN

Is this a Common Form? No		IC Status: Modified

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	none	AAP 6 Month Follow-up Survey	AAP Six Month Followup Training Evaluation Survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
AAP 6 Month Follow-up Survey - word	AAP Six Month Follow Up Evaluation Survey_Edited V3.docx	05/09/2017

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