Information Collection

FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey)

IC 220429 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 FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey)	Form and Instruction
0920-1129 FASD Prevention, Identification, & Alcohol Screening Pre NOFAS Pre-Test Survey (FASD Prevention Identification & Alcohol Screenin....pdf	Form and Instruction
0920-1129 FASD Prevention, Identification, & Alcohol Screening Pre NOFAS Pre-Test Survey (FASD Prevention Identification & Alcohol Screenin....pdf	Form and Instruction
NOFAS Pre-Test Survey (FASD Prevention Identification & Alcohol Screening Pre)_obgyn non-sub changes_REVIEWED.docx FASAD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation	IC Document
NOFAS Pre-Test Survey (FASD Prevention Identification & Alcohol Screening Pre)_obgyn non-sub changes_REVIEWED.docx FASAD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation	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	FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation	NOFAS Pre-Test Survey (FASD Prevention Identification & Alcohol Screenin....pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 551

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	-551	551
Annual IC Time Burden (Hours)	-28	28
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FASAD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation	NOFAS Pre-Test Survey (FASD Prevention Identification & Alcohol Screening Pre)_obgyn non-sub changes_REVIEWED.docx	07/20/2017

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