Pediatricians Survey

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

Documents and Forms

Document Name Document Type
Pediatricians Survey Form
Survey of Pediatricians S4 Survey of Pediatricians - Baseline and Follow Up.pdf Form
Survey of Pediatricians S4 Survey of Pediatricians - Baseline and Follow Up.pdf Form
I7 Survey of Pediatricians - Baseline and Follow Up.docx Survey of Pediatricians IC Document
I7 Survey of Pediatricians - Baseline and Follow Up.docx Survey of Pediatricians IC Document

Information Collection (IC) Details

IC Title:	Pediatricians Survey	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	Survey of Pediatricians	S4 Survey of Pediatricians - Baseline and Follow Up.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 534	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	-1,068	1,068
Annual IC Time Burden (Hours)	-178	178
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survey of Pediatricians	I7 Survey of Pediatricians - Baseline and Follow Up.docx	03/02/2016

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