OBGYN FASD-SBI Training Event Evaluation

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1129 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1129 OBGYN FASD-SBI Training Event Evaluation Form and Instruction
0920-1129 OBGYN FASD-SBI Training Event Evaluation OBGYN FASD SBI Training Event Evaluation_Screenshot_REVIEWED.PDF Form and Instruction
OBGYN FASD SBI Training Event Evaluation_REVIEWED renumbered.docx OBGYN FASD-SBI Training Event Evaluation - word IC Document

Information Collection (IC) Details

IC Title:	OBGYN FASD-SBI Training Event Evaluation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	0920-1129	OBGYN FASD-SBI Training Event Evaluation	OBGYN FASD SBI Training Event Evaluation_Screenshot_REVIEWED.PDF		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 124	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	124	0	124
Annual IC Time Burden (Hours)	8	4	4
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
OBGYN FASD-SBI Training Event Evaluation - word	OBGYN FASD SBI Training Event Evaluation_REVIEWED renumbered.docx	07/21/2017

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