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OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey)
Improving Fetal Alcohol Spectrum Disorders Prevention and Practice through Practice and Implementation Centers and National Partnerships
OMB: 0920-1129
IC ID: 220396
OMB.report
HHS/CDC
OMB 0920-1129
ICR 202102-0920-003
IC 220396
( )
Documents and Forms
Document Name
Document Type
Form 0920-1129
OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey)
Form and Instruction
0920-1129 OBGYN Guided Brief Intervention Satisfaction Survey
OBGYN Avatar Satisfaction Survey (Guided Brief Intervention Survey)_Scre....pdf
Form and Instruction
0920-1129 OBGYN Guided Brief Intervention Satisfaction Survey
OBGYN Avatar Satisfaction Survey (Guided Brief Intervention Survey)_Scre....pdf
Form and Instruction
H5 OBGYN Avatar Training Satisfaction Survey.docx
OBGYN Avatar Training Survey - word
IC Document
H5 OBGYN Avatar Training Satisfaction Survey.docx
OBGYN Avatar Training Survey - word
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey)
Agency IC Tracking Number:
0920-1129 17AUR
Is this a Common Form?
No
IC Status:
Removed
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 Guided Brief Intervention Satisfaction Survey
OBGYN Avatar Satisfaction Survey (Guided Brief Intervention Survey)_Scre....pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
120
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
0
0
0
-120
120
0
Annual IC Time Burden (Hours)
0
0
0
-6
6
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OBGYN Avatar Training Survey - word
H5 OBGYN Avatar Training Satisfaction Survey.docx
03/02/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.