Assessment of a Training Program to Improve Continuity of Care for Children and Families Affected by Fetal Alcohol Spectrum Disorders (FASD)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Resident-Trainee Overall Program Evaluation	Form and Instruction	New	Available
Resident Overall Program Assessment	Form and Instruction	New	Repair queued
Post-training Evaluation Survey	Form and Instruction	New	Available
Resident Overall Effects & Prevalence Video Post-test	Form and Instruction	New	Repair queued
Pre-training Evaluation Survey	Form and Instruction	New	Available
Resident Overall Effects & Prevalence Video Pretest	Form and Instruction	New	Repair queued
Application Survey for the Improving Continuity of Care for Children and Families Affected by Prenatal Alcohol Exposure	Form and Instruction	New	Available
Attending Physicians Application	Form and Instruction	New	Repair queued
Attending Physician Debrief Questionnaire - Facilitator Guide	Form and Instruction	New	Available
Attending Physicians Debriefing	Form and Instruction	New	Repair queued
FASD Precepting Attending Program Evaluation	Form and Instruction	New	Available
Attending Physicians Overall Program Assessment	Form and Instruction	New	Repair queued
FASD Train the Trainer Session Evaluation	Form and Instruction	New	Available
Attending Physicians Training Program Assessment	Form and Instruction	New	Repair queued
Educational Care for Children Affected by Prenatal Alcohol Exposure (post-training evaluation survey)	Form and Instruction	New	Available
Attending Physicians Educational Care (post-test)	Form and Instruction	New	Repair queued
Educational Care for Children Affected by Prenatal Alcohol Exposure (pre-training evaluation survey)	Form and Instruction	New	Available
Attending Physicians Educational Care (pre-test)	Form and Instruction	New	Repair queued
Overcoming Social Attitudes as a Barrier to Early Identification of FASD (post-training evaluation survey)	Form and Instruction	New	Available
Attending Physicians Overcoming Social Attitudes (post-test)	Form and Instruction	New	Available
Overcoming Social Attitudes as a Barrier to Early Identification of FASD (pre-training evaluation survey)	Form and Instruction	New	Available
Attending Physicians Overcoming Social Attitudes (pre-test)	Form and Instruction	New	Repair queued
Treatment Across the Lifespan for Persons with FASD (post-training evaluation survey)	Form and Instruction	New	Available
Attending Physicians Treatment Across the Lifespan (post-test)	Form and Instruction	New	Repair queued
Treatment Across the Lifespan for Persons with FASD (pre-training evaluation survey)	Form and Instruction	New	Repair queued
Attending Physicians Treatment Across the Lifespan (pre-test)	Form and Instruction	New	Repair queued
FASD: Screening, Assessment, & Diagnosis (post-training evaluation survey)	Form and Instruction	New	Available
Attending Physicians Screening & Diagnosis (post-test)	Form and Instruction	New	Repair queued
FASD: Screening, Assessment, & Diagnosis (pre-training evaluation survey)	Form and Instruction	New	Repair queued
Attending Physicians Screening and Diagnosis (pre-test)	Form and Instruction	New	Repair queued
SSA_AAP FASD Resident Training_07152021.docx	Supporting Statement A	Uploaded 2021-07-15	Repair queued
A15b_recruiting materials.docx	Supplementary Document	Uploaded 2021-07-14	Repair queued
A16_60 day FRN_published 03082021.pdf	Supplementary Document	Uploaded 2021-07-14	Repair queued
A17 Section 301 of the Public Health Service Act_0920-1129.docx	Supplementary Document	Uploaded 2021-07-14	Repair queued
SSB_AAP FASD Resident Training_07142021.docx	Supporting Statement B	Uploaded 2021-07-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
248410	Resident Overall Program Assessment	Form and Instruction	New	Resident-Trainee Overall Program Evaluation
248410	Resident Overall Program Assessment	Form and Instruction	New
248409	Resident Overall Effects & Prevalence Video Post-test	Form and Instruction	New	Post-training Evaluation Survey
248409	Resident Overall Effects & Prevalence Video Post-test	Form and Instruction	New
248408	Resident Overall Effects & Prevalence Video Pretest	Form and Instruction	New	Pre-training Evaluation Survey
248408	Resident Overall Effects & Prevalence Video Pretest	Form and Instruction	New
248407	Attending Physicians Application	Form and Instruction	New	Application Survey for the Improving Continuity of Care for Children and Families Affected by Prenatal Alcohol Exposure
248407	Attending Physicians Application	Form and Instruction	New
248406	Attending Physicians Debriefing	Form and Instruction	New	Attending Physician Debrief Questionnaire - Facilitator Guide
248406	Attending Physicians Debriefing	Form and Instruction	New
248405	Attending Physicians Overall Program Assessment	Form and Instruction	New	FASD Precepting Attending Program Evaluation
248405	Attending Physicians Overall Program Assessment	Form and Instruction	New
248404	Attending Physicians Training Program Assessment	Form and Instruction	New	FASD Train the Trainer Session Evaluation
248404	Attending Physicians Training Program Assessment	Form and Instruction	New
248402	Attending Physicians Educational Care (post-test)	Form and Instruction	New	Educational Care for Children Affected by Prenatal Alcohol Exposure (post-training evaluation survey)
248402	Attending Physicians Educational Care (post-test)	Form and Instruction	New
248401	Attending Physicians Educational Care (pre-test)	Form and Instruction	New	Educational Care for Children Affected by Prenatal Alcohol Exposure (pre-training evaluation survey)
248401	Attending Physicians Educational Care (pre-test)	Form and Instruction	New
248400	Attending Physicians Overcoming Social Attitudes (post-test)	Form and Instruction	New	Overcoming Social Attitudes as a Barrier to Early Identification of FASD (post-training evaluation survey)
248400	Attending Physicians Overcoming Social Attitudes (post-test)	Form and Instruction	New
248399	Attending Physicians Overcoming Social Attitudes (pre-test)	Form and Instruction	New	Overcoming Social Attitudes as a Barrier to Early Identification of FASD (pre-training evaluation survey)
248399	Attending Physicians Overcoming Social Attitudes (pre-test)	Form and Instruction	New
248398	Attending Physicians Treatment Across the Lifespan (post-test)	Form and Instruction	New	Treatment Across the Lifespan for Persons with FASD (post-training evaluation survey)
248398	Attending Physicians Treatment Across the Lifespan (post-test)	Form and Instruction	New
248397	Attending Physicians Treatment Across the Lifespan (pre-test)	Form and Instruction	New	Treatment Across the Lifespan for Persons with FASD (pre-training evaluation survey)
248397	Attending Physicians Treatment Across the Lifespan (pre-test)	Form and Instruction	New
248393	Attending Physicians Screening & Diagnosis (post-test)	Form and Instruction	New	FASD: Screening, Assessment, & Diagnosis (post-training evaluation survey)
248393	Attending Physicians Screening & Diagnosis (post-test)	Form and Instruction	New
248377	Attending Physicians Screening and Diagnosis (pre-test)	Form and Instruction	New	FASD: Screening, Assessment, & Diagnosis (pre-training evaluation survey)
248377	Attending Physicians Screening and Diagnosis (pre-test)	Form and Instruction	New

ICR Details

OMB Control No: 0920-1347	ICR Reference No: 202107-0920-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-21DJ
Title: Assessment of a Training Program to Improve Continuity of Care for Children and Families Affected by Fetal Alcohol Spectrum Disorders (FASD)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/31/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/19/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	36 Months From Approved
Responses	870	0	0
Time Burden (Hours)	223	0	0
Cost Burden (Dollars)	19,375	0	0

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Abstract: The purpose of this data collection is to evaluate a newly developed pediatric resident training curriculum regarding identification, referral and care of children with fetal alcohol spectrum disorders (FASD) and their families. Information will be collected by the American Academy of Pediatrics (AAP) staff through paper-and-pencil surveys for in-person training of attending physicians and by a secure online platform (Qualtrics) for resident trainees as well as the overall program evaluations for attending physicians. Attending physicians will also be asked to participate in a final project debriefing conference call. The overall objective of the training program is to improve recognition, diagnosis and treatment for children with FASD to improve their developmental, cognitive and educational outcomes.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 13391	03/08/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 38101	07/19/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

table that charts list of burden

IC Title	Form No.	Form Name
Attending Physicians Application	n/a	Application Survey for the Improving Continuity of Care for Children and Families Affected by Prenatal Alcohol Exposure
Attending Physicians Debriefing	n/a	Attending Physician Debrief Questionnaire - Facilitator Guide
Attending Physicians Educational Care (post-test)	n/a	Educational Care for Children Affected by Prenatal Alcohol Exposure (post-training evaluation survey)
Attending Physicians Educational Care (pre-test)	n/a	Educational Care for Children Affected by Prenatal Alcohol Exposure (pre-training evaluation survey)
Attending Physicians Overall Program Assessment	n/a	FASD Precepting Attending Program Evaluation
Attending Physicians Overcoming Social Attitudes (post-test)	n/a	Overcoming Social Attitudes as a Barrier to Early Identification of FASD (post-training evaluation survey)
Attending Physicians Overcoming Social Attitudes (pre-test)	n/a	Overcoming Social Attitudes as a Barrier to Early Identification of FASD (pre-training evaluation survey)
Attending Physicians Screening & Diagnosis (post-test)	n/a	FASD: Screening, Assessment, & Diagnosis (post-training evaluation survey)
Attending Physicians Screening and Diagnosis (pre-test)	n/a	FASD: Screening, Assessment, & Diagnosis (pre-training evaluation survey)
Attending Physicians Training Program Assessment	n/a	FASD Train the Trainer Session Evaluation
Attending Physicians Treatment Across the Lifespan (post-test)	n/a	Treatment Across the Lifespan for Persons with FASD (post-training evaluation survey)
Attending Physicians Treatment Across the Lifespan (pre-test)	n/a	Treatment Across the Lifespan for Persons with FASD (pre-training evaluation survey)
Resident Overall Effects & Prevalence Video Post-test	n/a	Post-training Evaluation Survey
Resident Overall Effects & Prevalence Video Pretest	n/a	Pre-training Evaluation Survey
Resident Overall Program Assessment	n/a	Resident-Trainee Overall Program Evaluation

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	870	0	0	870	0	0
Annual Time Burden (Hours)	223	0	0	223	0	0
Annual Cost Burden (Dollars)	19,375	0	0	19,375	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new, one-time information collection request.

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Annual Cost to Federal Government: $97,804

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/19/2021

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