Information Collection

OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey)

IC 220396 under ICR 202102-0920-003 · OMB 0920-1129.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1129 OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey)	Form and Instruction
0920-1129 OBGYN Guided Brief Intervention Satisfaction Survey OBGYN Avatar Satisfaction Survey (Guided Brief Intervention Survey)_Scre....pdf	Form and Instruction
0920-1129 OBGYN Guided Brief Intervention Satisfaction Survey OBGYN Avatar Satisfaction Survey (Guided Brief Intervention Survey)_Scre....pdf	Form and Instruction
H5 OBGYN Avatar Training Satisfaction Survey.docx OBGYN Avatar Training Survey - word	IC Document
H5 OBGYN Avatar Training Satisfaction Survey.docx OBGYN Avatar Training Survey - word	IC Document

IC Title:

Agency IC Tracking Number:

0920-1129 17AUR

Is this a Common Form? No

IC Status: Removed

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	0920-1129	OBGYN Guided Brief Intervention Satisfaction Survey	OBGYN Avatar Satisfaction Survey (Guided Brief Intervention Survey)_Scre....pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-120	120
Annual IC Time Burden (Hours)	-6	6
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OBGYN Avatar Training Survey - word	H5 OBGYN Avatar Training Satisfaction Survey.docx	03/02/2016

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