Health Professionals Survey

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

Documents and Forms

Document Name Document Type
Form 0920-1129 Health Professionals Survey Form and Instruction
0920-1129 Health Professionals Survey B1 Health Professionals Survey.docx Form and Instruction
0920-1129 Health Professionals Survey B1 Health Professionals Survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Health Professionals Survey	Agency IC Tracking Number:	0920-20QS

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR USC241 (To search for a specific CFR, visit the Code of Federal Regulations.)

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	Health Professionals Survey	B1 Health Professionals Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,013	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,013	4,013
Annual IC Time Burden (Hours)	602	602
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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