FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey)

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⚠️ Notice: This information collection may be referencing outdated material.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 FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey) Form and Instruction
0920-1129 FASD Prevention, Identification, & Alcohol Screening Pre NOFAS Pre-Test Survey (FASD Prevention Identification & Alcohol Screenin....pdf Form and Instruction
NOFAS Pre-Test Survey (FASD Prevention Identification & Alcohol Screening Pre)_obgyn non-sub changes_REVIEWED.docx FASAD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation IC Document

Information Collection (IC) Details

IC Title:	FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey)	Agency IC Tracking Number:	0920-1129 (17AUR)

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	FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation	NOFAS Pre-Test Survey (FASD Prevention Identification & Alcohol Screenin....pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 551	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	551	551
Annual IC Time Burden (Hours)	28	28
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
FASAD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation	NOFAS Pre-Test Survey (FASD Prevention Identification & Alcohol Screening Pre)_obgyn non-sub changes_REVIEWED.docx	07/20/2017

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