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Clinical Process Improvement Survey
Improving Fetal Alcohol Spectrum Disorders Prevention and Practice through Practice and Implementation Centers and National Partnerships
OMB: 0920-1129
IC ID: 220431
OMB.report
HHS/CDC
OMB 0920-1129
ICR 202102-0920-003
IC 220431
( )
Documents and Forms
Document Name
Document Type
Clinical Process Improvement Survey
Form
Clinical Process Improvement Survey
V1 Clinical Process Improvement Survey.pdf
Form
Clinical Process Improvement Survey
V1 Clinical Process Improvement Survey.pdf
Form
L1 Clinical Process Improvement Survey.doc
Clinical Process Improvement Survey - word
IC Document
L1 Clinical Process Improvement Survey.doc
Clinical Process Improvement Survey - word
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Clinical Process Improvement Survey
Agency IC Tracking Number:
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
none
Clinical Process Improvement Survey
V1 Clinical Process Improvement Survey.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:
246
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
-492
492
0
Annual IC Time Burden (Hours)
0
0
0
-82
82
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Clinical Process Improvement Survey - word
L1 Clinical Process Improvement Survey.doc
03/02/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.