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Federal forms, ICRs, and supporting documents

Information Collection

Adolescent SBIRT (A-SBIRT) Online Training (Kognito) Feedback Surveys

IC 229754 under ICR 201708-0990-001 · OMB 0990-0379.

Documents and Forms
Document Name
Document Type
Other-follow up survey
Other-Post survey
Other-Pre Survey
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Adolescent SBIRT (A-SBIRT) Online Training (Kognito) Feedback Surveys
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-follow up survey Wheeler Clinic Kognito_CT SBI with Adolescents - Follow up_Survey 5-21-18.pdf Yes Yes Fillable Fileable
Other-Post survey Wheeler Clinic Kognito_CT SBI with Adolescents - Post_Survey 5-21-18.pdf Yes Yes Fillable Fileable
Other-Pre Survey Wheeler Clinic Kognito_CT SBI with Adolescents - Pre _Survey 5-21-18.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

1,000 0
   
Individuals or Households
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,000 0 1,000 0 0 0
Annual IC Time Burden (Hours) 400 0 400 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SS_mini 0990-0379 Wheeler Fast Track OMB Clearance Form - Kognito Training Surveys- 5-21-18.docx 05/22/2018
Instructions Wheeler Clinic Adolescent SBI Kognito Registraion Instructions 5-23-18.docx 05/22/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.