Information Collection

Integrating Comprehensive Family-Centered Care into Substance Use Treatment Programs for Pregnant and Postpartum Women to Prevent the Intergenerational Transmission of Adverse Childhood Experiences

IC 253016 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⚠️ Notice: This information collection may be referencing outdated material.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 0920-1154 Survey Questionnaire Integrating Comprehensive Family-Centered Care into Substance Use Treatment Programs for Pregnant and Postpartum Women to Prevent the Intergenerational Transmission of Adverse Childhood Experiences	Form and Instruction
0920-1154 Survey Questionnaire Attachment C Survey questions_03.31.2022_final.docx	Form and Instruction
SSA_GenIC_FCSUT_03.31.2022_final.docx SSA	IC Document
SSB_GenIC_FCSUT_03.31.2022.docx SSB	IC Document
Attachment A ERB Determination_ CDC FCSUT 03.29.2022.pdf ERB Determination	IC Document
Attachment B Email and Email Follow Ups 03.31.2022.docx Email and Email Follow-ups	IC Document
Attachment D_PIA_FSCUT.pdf PIA	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Integrating Comprehensive Family-Centered Care into Substance Use Treatment Programs for Pregnant and Postpartum Women to Prevent the Intergenerational Transmission of Adverse Childhood Experiences

Agency IC Tracking Number:

0920-1154-22EJ

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1154				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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	400	400
Annual IC Time Burden (Hours)	101	101
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSA		04/22/2022
SSB		04/22/2022
ERB Determination		04/22/2022
Email and Email Follow-ups		04/22/2022
PIA		04/22/2022

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

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