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FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey)
Improving Fetal Alcohol Spectrum Disorders Prevention and Practice through Practice and Implementation Centers and National Partnerships
OMB: 0920-1129
IC ID: 220429
OMB.report
HHS/CDC
OMB 0920-1129
ICR 202102-0920-003
IC 220429
( )
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey)
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:
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
Federal Enterprise Architecture Business Reference Module
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 %
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
-551
551
0
Annual IC Time Burden (Hours)
0
0
0
-28
28
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.