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Pre-Training Survey (Nursing)
Improving Fetal Alcohol Spectrum Disorders Prevention and Practice through Practice and Implementation Centers and National Partnerships
OMB: 0920-1129
IC ID: 220383
OMB.report
HHS/CDC
OMB 0920-1129
ICR 202102-0920-003
IC 220383
( )
Documents and Forms
Document Name
Document Type
Pre-Training Survey (Nursing)
Form
Nursing Pre-Training Survey
G1 Pre Training Survey for Nursing.pdf
Form
Nursing Pre-Training Survey
G1 Pre Training Survey for Nursing.pdf
Form
UPDATED G1 Pre-Training Survey for Nursing.docx
Pre-Training Survey (Nursing)
IC Document
UPDATED G1 Pre-Training Survey for Nursing.docx
Pre-Training Survey (Nursing)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Pre-Training Survey (Nursing)
Agency IC Tracking Number:
17ADN
Is this a Common Form?
No
IC Status:
Removed
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
Nursing Pre-Training Survey
G1 Pre Training Survey for Nursing.pdf
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:
667
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
0
0
0
-667
667
0
Annual IC Time Burden (Hours)
0
0
0
-100
100
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Pre-Training Survey (Nursing)
UPDATED G1 Pre-Training Survey for Nursing.docx
05/09/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.