Resident Overall Effects & Prevalence Video Pretest

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

Documents and Forms

Document Name Document Type
Resident Overall Effects & Prevalence Video Pretest Form and Instruction
Pre-training Evaluation Survey A12_resident pretest.docx Form and Instruction
Pre-training Evaluation Survey A12_resident pretest.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Resident Overall Effects & Prevalence Video Pretest	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	n/a	Pre-training Evaluation Survey	A12_resident pretest.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: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	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)	5,546	5,546

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.