OBGYN Provider Follow-up

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

OMB: 0920-1129

IC ID: 220395

Information Collection (IC) Details

View Information Collection (IC)

OBGYN Provider Follow-up
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none OBGYN Provider Follow-up R4 OBGYN BI-MI Proficiency Rating Scale_Provider Follow Up (3m and 6m).pdf Yes Yes Fillable Fileable

Health Public Health Monitoring

 

600 0
   
Individuals or Households
 
   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 -1,200 1,200 0
Annual IC Time Burden (Hours) 0 0 0 -60 60 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
OBGYN Provider Follow-up - word H4 OBGYN BI-MI Proficiency Rating Scale - Provider Follow Up (3m & 6m).docx 03/02/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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