OBGYN Standardized Patient

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

Documents and Forms

Document Name Document Type
OBGYN Standardized Patient Form
OBGYN Standardized Patient R3 OBGYN BI-MI Proficiency Rating Scale_Standardized Patient Version.pdf Form
OBGYN Standardized Patient R3 OBGYN BI-MI Proficiency Rating Scale_Standardized Patient Version.pdf Form
H3 OBGYN BI-MI Proficiency Rating Scale - Standardized Patient Version.docx OBGYN Standardized Patient - word IC Document
H3 OBGYN BI-MI Proficiency Rating Scale - Standardized Patient Version.docx OBGYN Standardized Patient - word IC Document

Information Collection (IC) Details

IC Title:	OBGYN Standardized Patient	Agency IC Tracking Number:

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	OBGYN Standardized Patient	R3 OBGYN BI-MI Proficiency Rating Scale_Standardized Patient Version.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-600	600
Annual IC Time Burden (Hours)	-30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OBGYN Standardized Patient - word	H3 OBGYN BI-MI Proficiency Rating Scale - Standardized Patient Version.docx	03/02/2016

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