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

Latest forms, documents, and information collections
Document	Type
Form 0920-1129 B17 TCU Organizational Readiness Survey	Form and Instruction
Form 0920-1129 TCU Organizational Readiness Survey	Form and Instruction
Form 0920-1129 B16 Social Work & Family Physicians Pre-Training SurveyWeb-based version	Form and Instruction
Form 0920-1129 Social Work and Family Physicians 6 Month Follow-Up	Form and Instruction
Form 0292-1129 B14 Post-Test Treatment Across Lifespan	Form and Instruction
Form 0292-1129 Post-Test Treatment Across the Lifespan	Form and Instruction
Form 0920-1129 B12 Post-test ND-PAE	Form and Instruction
Form 0920-1129 Post-Test ND-PAE	Form and Instruction
Form 0920-1129 B11 Pre-test ND-PAE	Form and Instruction
Form 0920-1129 Pre-Test ND-PAE	Form and Instruction
Form 0920-1129 B10 Post-Test Screening, Assessment and Diagnosis	Form and Instruction
Form 0920-1129 Post-Test Screening, Assessment, and Diagnosis	Form and Instruction
Form 0920-1129 B8 Medical Assistants Change in Practice Survey	Form and Instruction
Form 0920-1129 Medical Assistants Change in Practice Survey	Form and Instruction
Form 0920-1129 B7 Medical Assistants Post-Test Survey	Form and Instruction
Form 0920-1129 Medical Assistants Post-Test Survey	Form and Instruction
Form 0920-1129 B5 Key Informant Interviews with Champions	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 092-1129 Health Professionals Survey (Nursing)	Form and Instruction
Form 0920-1129 Core Post-Training Survey	Form and Instruction
Form 0920-1129 FASD Core Training Survey Post-Test	Form and Instruction
Form 0920-1129 Core Pre-Test Survey	Form and Instruction
Form 0920-1129 Core Pre Test	Form and Instruction
Form 0920-1129 Health Professionals Survey	Form and Instruction
Form 0920-1129 Health Professionals Survey	Form and Instruction
TCU Organizational Readiness Survey	Form
TCU Organizational Readiness Survey	Form
Organizational Readiness Survey	Form
Organizational Readiness Survey	Form
Clinical Process Improvement Survey	Form
Clinical Process Improvement Survey	Form
Form 0920-1129 FASD Prevention, Identification, & Alcohol Screening Post-Training Evaluation	Form and Instruction
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	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 3 month Survey	Form
NOFAS Webinar Survey	Form
NOFAS Webinar Survey	Form
Social Work and Family Physician Follow-up 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 Post-training Survey	Form
Social Work and Family Physician Pre-training Survey	Form
Social Work and Family Physician Pre-training Survey	Form
Family Medicine Evaluation	Form
Family Medicine Evaluation	Form
FASD Training Evaluation	Form
FASD Training Evaluation	Form
FASD Work Plan	Form
FASD Work Plan	Form
FASD Toolkit User Survey	Form
FASD Toolkit User Survey	Form
Form 0920-1129 Academia Americana De Pediatria Ciiestionario De Elaluacion Posterior A La Capacitacion	Form and Instruction
Form 0920-1129 AAP Post-Training Evaluation Survey (Pediatrics)	Form and Instruction
Form 0920-1129 Academia Americana De Pediatria Encuesta De Evaluacion De Seguimento De 6 Meses	Form and Instruction
Form 0920-1129 AAP Pre-Training Evaluation Survey (Pediatrics)	Form and Instruction
Form 0920-1129 AAP Six-Month Follow-Up Evaluation Survey	Form and Instruction
Form 0920-1129 AAP 6 Month Follow-up Evaluation Survey (Pediatrics)	Form and Instruction
Form 0920-1129 AAP Three-month Follow-up Evaluation Survey	Form and Instruction
Form 0920-1129 AAP 3 Month Follow-up Survey (Pediatrics)	Form and Instruction
Survey of Pediatricians	Form
Pediatricians Survey	Form
Medical Assistants Change in Practice Survey	Form
Medical Assistants Change in Practice Survey	Form
Medical Assistants Folow-up Survey - Academic	Form
Medical Assistants Follow-up Survey - Academic	Form
Medical Assistants Follow-up Survey	Form
Medical Assistants Follow-up Survey	Form
Medical Assistants Post-test Survey - Academic	Form
Medical Assistants Post-test Survey - Academic	Form
Medical Assistants Post-test Survey	Form
Medical Assistants Post-test Survey	Form
Medical Assistants Pre-test Survey - Academic	Form
Medical Assistants Pre-test Survey - Academic	Form
Medical Assistants Pre-test Survey	Form
Medical Assistants Pre-test Survey	Form
Form 0920-1129 OBGYN Telecom Training Satisfaction Survey (TTS)	Form and Instruction
OBGYN Informant Interview - Posttraining	Form
OBGYN Informant Interview - Posttraining	Form
OBGYN Informant Interview - Pretraining	Form
OBGYN Informant Interview - Pretraining	Form
Form 0920-1129 OBGYN FASD-SBI Training Event Evaluation	Form and Instruction
Form 0920-1129 OBGYN FASD-SBI Training Event Evaluation	Form and Instruction
Form 0920-1129 OBGYN Guided Brief Intervention Satisfaction Survey	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 Provider Follow-up	Form
OBGYN Standardized Patient	Form
OBGYN Standardized Patient	Form
OBGYN Provider Skills Baseline	Form
OBGYN Provider Skills Baseline	Form
OBGYN Knowledge and Agency	Form
OBGYN Knowledge and Agency	Form
Healthcare Organization Survey	Form
Healthcare Organization Survey	Form
Nursing Network Survey	Form
Nursing Network Survey	Form
Form nopne Nursing Organization Questionnaire	Form
Form nopne Nursing Organization Questionnaire	Form
Nursing DSW Polling	Form
Nursing DSW Polling	Form
Nursing Training Follow-up Survey	Form
Six-Month Follow-Up Training Survey (Nursing)	Form
Nursing Post-training Survey	Form
Pre-Training Survey (Nursing)	Form
Nursing Pre-Training Survey	Form
Pre-Training Survey (Nursing)	Form
DSW Report	Form
DSW Report	Form
FASD Training Survey - follow-up	Form
FASD Core Training - 6 month follow-up	Form
FASD Post-training survey	Form
FASD Core Training Survey - Post-test	Form
Form 0920-1129 FASD Prevention, Identification & Alcohol Screening Pre-Training Evaluation	Form and Instruction
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
TCU Organizational Readiness Survey	Form and Instruction
Social Work and Family Physicians 6 Month Follow-Up	Form and Instruction
Social Work and Family Physicians 6 Month Follow-Up	Form and Instruction
Social Work and Family Physicians Pre-Training Survey	Information collection
Post-Test Treatment Across the Lifespan	Form and Instruction
Post-Test Treatment Across the Lifespan	Form and Instruction
Pre-Test Treatment Across the Lifespan	Information collection
Post-Test ND-PAE	Form and Instruction
Post-Test ND-PAE	Form and Instruction
Pre-Test ND-PAE	Form and Instruction
Pre-Test ND-PAE	Form and Instruction
Post-Test Screening, Assessment, and Diagnosis	Form and Instruction
Post-Test Screening, Assessment, and Diagnosis	Form and Instruction
Pre-Test Screening, Assessment, and Diagnosis	Information collection
Medical Assistants Change in Practice Survey	Form and Instruction
Medical Assistants Change in Practice Survey	Form and Instruction
Medical Assistants Post-Test Survey	Form and Instruction
Medical Assistants Post-Test Survey	Form and Instruction
Medical Assistants Pre-Test Survey	Information collection
Key Informant Interviews with Champions	Form and Instruction
Key Informant Interviews with Champions	Form and Instruction
Health Professionals Survey (Nursing)	Form and Instruction
Health Professionals Survey (Nursing)	Form and Instruction
FASD Core Training Survey Post-Test	Form and Instruction
FASD Core Training Survey Post-Test	Form and Instruction
Core Pre Test	Form and Instruction
Core Pre Test	Form and Instruction
Health Professionals Survey	Form and Instruction
Health Professionals Survey	Form and Instruction
TCU Organizational Readiness Survey	Form
TCU Organizational Readiness Survey	Form
Organizational Readiness Survey	Form
Organizational Readiness Survey	Form
Clinical Process Improvement 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 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
FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey)	Form and Instruction
NOFAS Webinar 3 month Survey	Form
NOFAS Webinar 3 month Survey	Form
NOFAS Webinar Survey	Form
NOFAS Webinar Survey	Form
Social Work and Family Physician Follow-up 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 Post-training Survey	Form
Social Work and Family Physician Pre-training Survey	Form
Social Work and Family Physician Pre-training Survey	Form
Family Medicine Evaluation	Form
Family Medicine Evaluation	Form
FASD Training Evaluation	Form
FASD Training Evaluation	Form
FASD Work Plan	Form
FASD Work Plan	Form
FASD Toolkit Focus Group Guide	Other-Discussion Guide
FASD Toolkit User Survey	Form
FASD Toolkit User Survey	Form
AAP Post-Training Evaluation Survey (Pediatrics)	Form and Instruction
AAP Post-Training Evaluation Survey (Pediatrics)	Form and Instruction
AAP Pre-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 6 Month Follow-up Evaluation Survey (Pediatrics)	Form and Instruction
AAP 3 Month Follow-up Survey (Pediatrics)	Form and Instruction
AAP 3 Month Follow-up Survey (Pediatrics)	Form and Instruction
Pediatricians Survey	Form
Pediatricians Survey	Form
Medical Assistants Change in Practice Survey	Form
Medical Assistants Change in Practice Survey	Form
Medical Assistants Follow-up Survey - Academic	Form
Medical Assistants Follow-up Survey - Academic	Form
Medical Assistants Follow-up Survey	Form
Medical Assistants Follow-up Survey	Form
Medical Assistants Post-test Survey - Academic	Form
Medical Assistants Post-test Survey - Academic	Form
Medical Assistants Post-test Survey	Form
Medical Assistants Post-test Survey	Form
Medical Assistants Pre-test Survey - Academic	Form
Medical Assistants Pre-test Survey - Academic	Form
Medical Assistants Pre-test Survey	Form
Medical Assistants Pre-test Survey	Form
OBGYN Telecom Training Survey	Form and Instruction
OBGYN Telecom Training Survey	Other-WORD
OBGYN Informant Interview - Posttraining	Form
OBGYN Informant Interview - Posttraining	Form
OBGYN Informant Interview - Pretraining	Form
OBGYN Informant Interview - Pretraining	Form
OBGYN FASD-SBI Training Event Evaluation	Form and Instruction
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 Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey)	Form and Instruction
OBGYN Provider Follow-up	Form
OBGYN Provider Follow-up	Form
OBGYN Standardized Patient	Form
OBGYN Standardized Patient	Form
OBGYN Provider Skills Baseline	Form
OBGYN Provider Skills Baseline	Form
OBGYN Knowledge and Agency	Form
OBGYN Knowledge and Agency	Form
Healthcare Organization Survey	Form
Healthcare Organization Survey	Form
Nursing Network Survey	Form
Nursing Network Survey	Form
Nursing Organization Questionnaire	Form
Nursing Organization Questionnaire	Form
Nursing Informant Interview	Other-Interview Guide
Nursing DSW Polling	Form
Nursing DSW Polling	Form
Six-Month Follow-Up Training Survey (Nursing)	Form
Six-Month Follow-Up Training Survey (Nursing)	Form
Pre-Training Survey (Nursing)	Form
Pre-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
DSW Report	Form
FASD Core Training - 6 month follow-up	Form
FASD Core Training - 6 month follow-up	Form
FASD Core Training Survey - Post-test	Form
FASD Core Training Survey - Post-test	Form
FASD Core Training Survey Pre-test	Form and Instruction
FASD Core Training Survey Pre-test	Form and Instruction
FASD Core Training Survey Pre-test	Other-WORD

All Historical Document Collections

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