Organizational Readiness 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⚠️ Notice: This information collection may be referencing outdated material.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
Organizational Readiness Survey Form
Organizational Readiness Survey V2 Organizational Readiness to Change.pdf Form
L2 Organizational Readiness to Change.doc Organizational Readiness Survey - word IC Document

Information Collection (IC) Details

IC Title:	Organizational Readiness Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	none	Organizational Readiness Survey	V2 Organizational Readiness to Change.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 220	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	440	440
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Organizational Readiness Survey - word	L2 Organizational Readiness to Change.doc	03/02/2016

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