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AAP 6 Month Follow-up Evaluation Survey (Pediatrics)
Improving Fetal Alcohol Spectrum Disorders Prevention and Practice through Practice and Implementation Centers and National Partnerships
OMB: 0920-1129
IC ID: 220412
OMB.report
HHS/CDC
OMB 0920-1129
ICR 202102-0920-003
IC 220412
( )
Documents and Forms
Document Name
Document Type
Form 0920-1129
AAP 6 Month Follow-up Evaluation Survey (Pediatrics)
Form and Instruction
0920-1129 AAP Six-Month Follow-Up Evaluation Survey
AAP Six_Month_Followup_Training_Evaluation_Survey_Spanish_Screenshot_REV....pdf
Form and Instruction
0920-1129 AAP Six-Month Follow-Up Evaluation Survey
AAP Six_Month_Followup_Training_Evaluation_Survey_Spanish_Screenshot_REV....pdf
Form and Instruction
AAP Six Month Follow Up Evaluation Survey_Final_Spanish_REVIEWED.docx
AAP Six-Month Follow-Up Trainig Evaluation Survey (SPANISH)
IC Document
AAP Six Month Follow Up Evaluation Survey_Final_Spanish_REVIEWED.docx
AAP Six-Month Follow-Up Trainig Evaluation Survey (SPANISH)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
AAP 6 Month Follow-up Evaluation Survey (Pediatrics)
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
AAP Six-Month Follow-Up Evaluation Survey
AAP Six_Month_Followup_Training_Evaluation_Survey_Spanish_Screenshot_REV....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
-10
10
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
AAP Six-Month Follow-Up Trainig Evaluation Survey (SPANISH)
AAP Six Month Follow Up Evaluation Survey_Final_Spanish_REVIEWED.docx
07/20/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.