OMB control number

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

OMB 0920-1129 · HHS/CDC.

OMB 0920-1129

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1129 TCU Organizational Readiness Survey Form and Instruction
Form 0920-1129 Social Work and Family Physicians 6 Month Follow-Up Form and Instruction
Form 0292-1129 Post-Test Treatment Across the Lifespan Form and Instruction
Form 0920-1129 Post-Test ND-PAE Form and Instruction
Form 0920-1129 Pre-Test ND-PAE Form and Instruction
Form 0920-1129 Post-Test Screening, Assessment, and Diagnosis Form and Instruction
Form 0920-1129 Medical Assistants Change in Practice Survey Form and Instruction
Form 0920-1129 Medical Assistants Post-Test Survey Form and Instruction
Form 0920-1129 Key Informant Interviews with Champions Form and Instruction
Form 092-1129 Health Professionals Survey (Nursing) Form and Instruction
Form 0920-1129 FASD Core Training Survey Post-Test Form and Instruction
Form 0920-1129 Core Pre Test Form and Instruction
Form 0920-1129 Health Professionals Survey Form and Instruction
TCU Organizational Readiness Survey Form
Organizational Readiness Survey Form
Clinical Process Improvement Survey Form
Form 0920-1129 FASD Prevention, Identification, & Alcohol Screening Post-Training Evaluation (previously NO FAS Post-Test Survey) Form and Instruction
Form 0920-1129 FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey) Form and Instruction
NOFAS Webinar 3 month Survey Form
NOFAS Webinar Survey Form
Social Work and Family Physician Follow-up Survey Form
Social Work and Family Physician Post-training Survey Form
Social Work and Family Physician Pre-training Survey Form
Family Medicine Evaluation Form
FASD Training Evaluation Form
FASD Work Plan Form
FASD Toolkit User Survey Form
Form 0920-1129 AAP Post-Training Evaluation Survey (Pediatrics) Form and Instruction
Form 0920-1129 AAP Pre-Training Evaluation Survey (Pediatrics) Form and Instruction
Form 0920-1129 AAP 6 Month Follow-up Evaluation Survey (Pediatrics) Form and Instruction
Form 0920-1129 AAP 3 Month Follow-up Survey (Pediatrics) Form and Instruction
Pediatricians Survey Form
Medical Assistants Change in Practice Survey Form
Medical Assistants Follow-up Survey - Academic Form
Medical Assistants Follow-up Survey Form
Medical Assistants Post-test Survey - Academic Form
Medical Assistants Post-test Survey Form
Medical Assistants Pre-test Survey - Academic Form
Medical Assistants Pre-test Survey Form
OBGYN Informant Interview - Posttraining Form
OBGYN Informant Interview - Pretraining Form
Form 0920-1129 OBGYN FASD-SBI Training Event Evaluation Form and Instruction
Form 0920-1129 OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey) Form and Instruction
OBGYN Provider Follow-up Form
OBGYN Standardized Patient Form
OBGYN Provider Skills Baseline Form
OBGYN Knowledge and Agency Form
Healthcare Organization Survey Form
Nursing Network Survey Form
Form nopne Nursing Organization Questionnaire Form
Nursing DSW Polling Form
Six-Month Follow-Up Training Survey (Nursing) Form
Pre-Training Survey (Nursing) Form
Pre-Training Survey (Nursing) Form
DSW Report Form
FASD Core Training - 6 month follow-up Form
FASD Core Training Survey - Post-test Form
Form 0920-1129 FASD Core Training Survey Pre-test Form and Instruction
D3 Social Work & Family Physicians 6 Month Follow Up Survey_Web-based version.pdf Supplementary Document
D2 Social Work & Family Physicians Pre-Training Survey_Web-based version.pdf Supplementary Document
D1 Medical Assistants Change in Practice Survey_Web-based version.pdf Supplementary Document
7. Att.A_Authorizing Language_A1 Section 301 of the Public Health Service Act_0920-1129.docx Supplementary Document
5. IRB Form_0920-1129 Improving FASD.pdf Supplementary Document
60Day FRN 101320.pdf Supplementary Document
30 Day FRN 012820.pdf Supplementary Document
2. SupportingStatementPartB_0920-1129 Improving FASD 12 08 2020_30DayFRN.docx Supporting Statement B
1. SupportingStatementPartA_0920-1129 Improving FASD 12 8 2020.docx Supporting Statement A
TCU Organizational Readiness Survey Form and Instruction
Social Work and Family Physicians 6 Month Follow-Up Form and Instruction
Social Work and Family Physicians Pre-Training Survey
Post-Test Treatment Across the Lifespan Form and Instruction
Pre-Test Treatment Across the Lifespan
Post-Test ND-PAE Form and Instruction
Pre-Test ND-PAE Form and Instruction
Post-Test Screening, Assessment, and Diagnosis Form and Instruction
Pre-Test Screening, Assessment, and Diagnosis
Medical Assistants Change in Practice Survey Form and Instruction
Medical Assistants Post-Test Survey Form and Instruction
Medical Assistants Pre-Test Survey
Key Informant Interviews with Champions Form and Instruction
Health Professionals Survey (Nursing) Form and Instruction
FASD Core Training Survey Post-Test Form and Instruction
Core Pre Test Form and Instruction
Health Professionals Survey Form and Instruction
TCU Organizational Readiness Survey Form
Organizational Readiness Survey Form
Clinical Process Improvement Survey Form
FASD Prevention, Identification, & Alcohol Screening Post-Training Evaluation (previously NO FAS Post-Test Survey) Form and Instruction
FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey) Form and Instruction
NOFAS Webinar 3 month Survey Form
NOFAS Webinar Survey Form
Social Work and Family Physician Follow-up Survey Form
Social Work and Family Physician Post-training Survey Form
Social Work and Family Physician Pre-training Survey Form
Family Medicine Evaluation Form
FASD Training Evaluation Form
FASD Work Plan Form
FASD Toolkit Focus Group Guide Other-Discussion Guide
FASD Toolkit User Survey Form
AAP Post-Training Evaluation Survey (Pediatrics) Form and Instruction
AAP Pre-Training Evaluation Survey (Pediatrics) Form and Instruction
AAP 6 Month Follow-up Evaluation Survey (Pediatrics) Form and Instruction
AAP 3 Month Follow-up Survey (Pediatrics) Form and Instruction
Pediatricians Survey Form
Medical Assistants Change in Practice Survey Form
Medical Assistants Follow-up Survey - Academic Form
Medical Assistants Follow-up Survey Form
Medical Assistants Post-test Survey - Academic Form
Medical Assistants Post-test Survey Form
Medical Assistants Pre-test Survey - Academic Form
Medical Assistants Pre-test Survey Form
OBGYN Telecom Training Survey Other-WORD
OBGYN Informant Interview - Posttraining Form
OBGYN Informant Interview - Pretraining Form
OBGYN FASD-SBI Training Event Evaluation Form and Instruction
OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey) Form and Instruction
OBGYN Provider Follow-up Form
OBGYN Standardized Patient Form
OBGYN Provider Skills Baseline Form
OBGYN Knowledge and Agency Form
Healthcare Organization Survey Form
Nursing Network Survey Form
Nursing Organization Questionnaire Form
Nursing Informant Interview Other-Interview Guide
Nursing DSW Polling Form
Six-Month Follow-Up Training Survey (Nursing) Form
Pre-Training Survey (Nursing) Form
Pre-Training Survey (Nursing) Form
High Impact Study - Informant Interview Other-Interview Guide
HIgh Impact Study - Discussion Guide Other-Discussion Guide
DSW Report Form
FASD Core Training - 6 month follow-up Form
FASD Core Training Survey - Post-test Form
FASD Core Training Survey Pre-test Form and Instruction

All Historical Document Collections

202102-0920-003 Approved without change	Reinstatement without change of a previously approved collection	2021-02-08
201707-0920-006 Approved with change	No material or nonsubstantive change to a currently approved collection	2017-07-21
201704-0920-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2017-05-10
201603-0920-002 Approved without change	New collection (Request for a new OMB Control Number)	2016-03-09