Information Collection

American Academy of Pediatrics Resident Training in Developmental Continuity Clinics (part 3)

IC 242950 under ICR 201912-0920-003 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-20MD American Academy of Pediatrics Resident Training in Developmental Continuity Clinics (part 3)	Form and Instruction
0920-20MD Attachment A1_Attending Physicians_Screening & Diagnosis Attachment A1_Attending Physicians_Screening & Diagnosis pretest.docx	Form and Instruction
0920-20MD Attachment A2_Attending Physicians_Screening & Diagnosis Attachment A2_Attending Physicians_Screening & Diagnosis post test.docx	Form and Instruction
0920-20MD Attachment A3_Attending Physicians_Treatment Across Life Attachment A3_Attending Physicians_Treatment Across Lifespan pretest Revised July 29 2020.docx	Form and Instruction
0920-20MD Attachment A4_Attending Physicians_Treatment Across Life Attachment A4_Attending Physicians_Treatment Across Lifespan post test.docx	Form and Instruction
0920-20MD Attachment A5_Attending Physicians_Overcoming Social Att Attachment A5_Attending Physicians_Overcoming Social Attitudes pretest Revised July 28 2020.docx	Form and Instruction
0920-20MD Attachment A6_Attending Physicians_Overcoming Social Att Attachment A6_Attending Physicians_Overcoming Social Attitudes post test.docx	Form and Instruction
0920-20MD Attachment A7_Attending Physicians_Educational Care pret Attachment A7_Attending Physicians_Educational Care pretest Revised July 28 2020.docx	Form and Instruction
0920-20MD Attachment A9_Attending Physicians_Training Program Eval Attachment A9_Attending Physicians_Training Program Evaluation.docx	Form and Instruction
0920-20MD Attachment A10_Resident_Overall Effects & Prevalence vid Attachment A10_Resident_Overall Effects & Prevalence video pretest Revised July 28 2020.docx	Form and Instruction
0920-20MD Attachment A11_Resident_Overall Effects & Prevalence vid Attachment A11_Resident_Overall Effects & Prevalence video post test.docx	Form and Instruction
0920-20MD Attachment A12_Resident_Overall Program Evaluation Attachment A12_Resident_Overall Program Evaluation.docx	Form and Instruction
0920-20MD Attachment A13_Attending Physician_Overall Program Evalu Attachment A13_Attending Physician_Overall Program Evaluation.docx	Form and Instruction
Att Public Health Service Act.pdf Att Public Health Service Act	IC Document
GenICRequestTemplate_AAP Continuity Clinic Project_July 16 2020.docx GenIC Request	IC Document
GenICRequestTemplate_STATEMENT B_AAP Continuity Clinic Project_July 16 2020.docx SSB	IC Document
IRB approval form.pdf IRB	IC Document
Privacy Act Checklist_AAP Continuity Clinic project.docx Privacy Act Checklist	IC Document
SupportingStatementPartA_AAP Continuity Clinic Project_July 16 2020.docx SSA	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

American Academy of Pediatrics Resident Training in Developmental Continuity Clinics (part 3)

Agency IC Tracking Number:

0920-20MD

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-20MD	Attachment A1_Attending Physicians_Screening & Diagnosis pretest	Attachment A1_Attending Physicians_Screening & Diagnosis pretest.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A2_Attending Physicians_Screening & Diagnosis post test	Attachment A2_Attending Physicians_Screening & Diagnosis post test.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A3_Attending Physicians_Treatment Across Lifespan pretest	Attachment A3_Attending Physicians_Treatment Across Lifespan pretest Revised July 29 2020.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A4_Attending Physicians_Treatment Across Lifespan post test	Attachment A4_Attending Physicians_Treatment Across Lifespan post test.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A5_Attending Physicians_Overcoming Social Attitudes pretest	Attachment A5_Attending Physicians_Overcoming Social Attitudes pretest Revised July 28 2020.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A6_Attending Physicians_Overcoming Social Attitudes post test	Attachment A6_Attending Physicians_Overcoming Social Attitudes post test.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A7_Attending Physicians_Educational Care pretest	Attachment A7_Attending Physicians_Educational Care pretest Revised July 28 2020.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A9_Attending Physicians_Training Program Evaluation	Attachment A9_Attending Physicians_Training Program Evaluation.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A10_Resident_Overall Effects & Prevalence video pretest	Attachment A10_Resident_Overall Effects & Prevalence video pretest Revised July 28 2020.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A11_Resident_Overall Effects & Prevalence video post test	Attachment A11_Resident_Overall Effects & Prevalence video post test.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A12_Resident_Overall Program Evaluation	Attachment A12_Resident_Overall Program Evaluation.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-20MD	Attachment A13_Attending Physician_Overall Program Evaluation	Attachment A13_Attending Physician_Overall Program Evaluation.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 160

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	160	160
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att Public Health Service Act	Att Public Health Service Act.pdf	08/03/2020
GenIC Request	GenICRequestTemplate_AAP Continuity Clinic Project_July 16 2020.docx	08/03/2020
SSB	GenICRequestTemplate_STATEMENT B_AAP Continuity Clinic Project_July 16 2020.docx	08/03/2020
IRB	IRB approval form.pdf	08/03/2020
Privacy Act Checklist	Privacy Act Checklist_AAP Continuity Clinic project.docx	08/03/2020
SSA	SupportingStatementPartA_AAP Continuity Clinic Project_July 16 2020.docx	08/03/2020

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