Outcome Measures

Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence Diagnosis and Intervention Project

Documents and Forms

Document Name Document Type
Form Form I - DxInt. Ou Outcome Measures Form and Instruction
Form I - DxInt. Ou Form I - DxInt. Outcomes I- DxInt. Outcomes-I 0-7yrs.doc Form and Instruction
Form J - DxInt. Ou Form J - DxInt. Outcomes J. 8-18yrs. J- DxInt. Outcomes J. 8-18yrs.doc Form and Instruction
Consent forms.pdf Consent Forms IC Document

Information Collection (IC) Details

IC Title:	Outcome Measures	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	Form I - DxInt. Outcomes	Form I - DxInt. Outcomes	I- DxInt. Outcomes-I 0-7yrs.doc		Yes	Yes	Paper Only
Form and Instruction	Form J - DxInt. Outcomes J. 8-18yrs.	Form J - DxInt. Outcomes J. 8-18yrs.	J- DxInt. Outcomes J. 8-18yrs.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	320	320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent Forms	Consent forms.pdf	05/27/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.