Medical Assistants Change in Practice 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 Medical Assistants Change in Practice Survey Form and Instruction
0920-1129 B8 Medical Assistants Change in Practice Survey B8 Medical Assistants Change in Practice Survey.docx Form and Instruction
0920-1129 B8 Medical Assistants Change in Practice Survey B8 Medical Assistants Change in Practice Survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Medical Assistants Change in Practice Survey	Agency IC Tracking Number:	0920-1129

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 241

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	B8 Medical Assistants Change in Practice Survey	B8 Medical Assistants Change in Practice 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: 250	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	250	250
Annual IC Time Burden (Hours)	63	63
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.