OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Improving Fetal Alcohol Spectrum Disorders Prevention and Practice through Practice and Implementation Centers and National Partnerships

ICR 201707-0920-006 · OMB 0920-1129 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
TCU Organizational Readiness Survey Form Unchanged Available
Organizational Readiness Survey Form Unchanged Available
Clinical Process Improvement Survey Form Unchanged Available
Form 0920-1129 FASD Prevention, Identification, & Alcohol Screening Post-Training Evaluation (previously NO FAS Post-Test Survey) Form and Instruction Modified Available
Form 0920-1129 FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey) Form and Instruction Modified Available
NOFAS Webinar 3 month Survey Form Unchanged Available
NOFAS Webinar Survey Form Unchanged Available
Social Work and Family Physician Follow-up Survey Form Unchanged Available
Social Work and Family Physician Post-training Survey Form Unchanged Available
Social Work and Family Physician Pre-training Survey Form Unchanged Available
Family Medicine Evaluation Form Unchanged Available
FASD Training Evaluation Form Unchanged Available
FASD Work Plan Form Unchanged Available
FASD Toolkit User Survey Form Unchanged Available
Form 0920-1129 AAP Post-Training Evaluation Survey (Pediatrics) Form and Instruction Modified Available
Form 0920-1129 AAP Pre-Training Evaluation Survey (Pediatrics) Form and Instruction Modified Available
Form 0920-1129 AAP 6 Month Follow-up Evaluation Survey (Pediatrics) Form and Instruction Modified Available
Form 0920-1129 AAP 3 Month Follow-up Survey (Pediatrics) Form and Instruction Modified Available
Pediatricians Survey Form Unchanged Available
Medical Assistants Change in Practice Survey Form Unchanged Repair queued
Medical Assistants Follow-up Survey - Academic Form Unchanged Available
Medical Assistants Follow-up Survey Form Unchanged Repair queued
Medical Assistants Post-test Survey - Academic Form Unchanged Available
Medical Assistants Post-test Survey Form Unchanged Repair queued
Medical Assistants Pre-test Survey - Academic Form Unchanged Available
Medical Assistants Pre-test Survey Form Unchanged Available
Form 0920-1129 OBGYN Telecom Training Survey Form and Instruction Modified Available
OBGYN Informant Interview - Posttraining Form Unchanged Available
OBGYN Informant Interview - Pretraining Form Unchanged Available
Form 0920-1129 OBGYN FASD-SBI Training Event Evaluation Form and Instruction Modified Available
Form 0920-1129 OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey) Form and Instruction Modified Available
OBGYN Provider Follow-up Form Unchanged Available
OBGYN Standardized Patient Form Unchanged Available
OBGYN Provider Skills Baseline Form Unchanged Available
OBGYN Knowledge and Agency Form Unchanged Repair queued
Healthcare Organization Survey Form Unchanged Available
Nursing Network Survey Form Unchanged Available
Form nopne Nursing Organization Questionnaire Form Unchanged Available
Nursing DSW Polling Form Unchanged Available
Six-Month Follow-Up Training Survey (Nursing) Form Unchanged Available
Pre-Training Survey (Nursing) Form Unchanged Available
Pre-Training Survey (Nursing) Form Unchanged Available
DSW Report Form Unchanged Available
FASD Core Training - 6 month follow-up Form Unchanged Available
FASD Core Training Survey - Post-test Form Unchanged Available
Form 0920-1129 FASD Core Training Survey Pre-test Form and Instruction Modified Available
Non-Sub Change Request_FASD PICs_063017.docx Justification for No Material/Nonsubstantive Change Uploaded 2017-07-21 Available
Non-Sub Change Request_FASD PICs_050817.docx Justification for No Material/Nonsubstantive Change Uploaded 2017-05-09 Available
M FASD Evaluation Working Group Members.docx Supplementary Document Uploaded 2016-03-02 Available
C Public Comments from 60 Day FRN.pdf Supplementary Document Uploaded 2016-03-02 Available
60 Day FRN_CDC-2015-0081-0001.pdf Supplementary Document Uploaded 2016-03-02 Available
B Average_ Annualized_Cost_to_the_Federal_Government_12222015.docx Supplementary Document Uploaded 2016-03-02 Available
A1 Section 301 of the Public Health Service Act.docx Supplementary Document Uploaded 2016-03-02 Available
SupportingStatementPartB_FASD_PICS_and_Partners_Revised02112016.docx Supporting Statement B Uploaded 2016-03-02 Available
SupportingStatementPartA_FASD_PICS_and_Partners_Revised02112016.docx Supporting Statement A Uploaded 2016-03-02 Available
IC Document Collections
IC IDCollectionTypeStatusForm
220433 TCU Organizational Readiness Survey Form Unchanged
220432 Organizational Readiness Survey Form Unchanged
220431 Clinical Process Improvement Survey Form Unchanged
220430 FASD Prevention, Identification, & Alcohol Screening Post-Training Evaluation (previously NO FAS Post-Test Survey) Form and Instruction Modified
220429 FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey) Form and Instruction Modified
220428 NOFAS Webinar 3 month Survey Form Unchanged
220427 NOFAS Webinar Survey Form Unchanged
220426 Social Work and Family Physician Follow-up Survey Form Unchanged
220425 Social Work and Family Physician Post-training Survey Form Unchanged
220423 Social Work and Family Physician Pre-training Survey Form Unchanged
220422 Family Medicine Evaluation Form Unchanged
220421 FASD Training Evaluation Form Unchanged
220419 FASD Work Plan Form Unchanged
220418 FASD Toolkit Focus Group Guide Other-Discussion Guide Unchanged
220417 FASD Toolkit User Survey Form Unchanged
220416 AAP Post-Training Evaluation Survey (Pediatrics) Form and Instruction Modified
220414 AAP Pre-Training Evaluation Survey (Pediatrics) Form and Instruction Modified
220412 AAP 6 Month Follow-up Evaluation Survey (Pediatrics) Form and Instruction Modified
220411 AAP 3 Month Follow-up Survey (Pediatrics) Form and Instruction Modified
220410 Pediatricians Survey Form Unchanged
220408 Medical Assistants Change in Practice Survey Form Unchanged
220407 Medical Assistants Follow-up Survey - Academic Form Unchanged
220405 Medical Assistants Follow-up Survey Form Unchanged
220404 Medical Assistants Post-test Survey - Academic Form Unchanged
220403 Medical Assistants Post-test Survey Form Unchanged
220402 Medical Assistants Pre-test Survey - Academic Form Unchanged
220401 Medical Assistants Pre-test Survey Form Unchanged
220400 OBGYN Telecom Training Survey Form and Instruction Modified
220399 OBGYN Informant Interview - Posttraining Form Unchanged
220398 OBGYN Informant Interview - Pretraining Form Unchanged
220397 OBGYN FASD-SBI Training Event Evaluation Form and Instruction Modified
220396 OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey) Form and Instruction Modified
220395 OBGYN Provider Follow-up Form Unchanged
220394 OBGYN Standardized Patient Form Unchanged
220392 OBGYN Provider Skills Baseline Form Unchanged
220391 OBGYN Knowledge and Agency Form Unchanged
220390 Healthcare Organization Survey Form Unchanged
220389 Nursing Network Survey Form Unchanged
220388 Nursing Organization Questionnaire Form Unchanged
220387 Nursing Informant Interview Other-Interview Guide Unchanged
220386 Nursing DSW Polling Form Unchanged
220385 Six-Month Follow-Up Training Survey (Nursing) Form Unchanged
220384 Pre-Training Survey (Nursing) Form Unchanged
220383 Pre-Training Survey (Nursing) Form Unchanged
220382 High Impact Study - Informant Interview Other-Interview Guide Unchanged
220381 HIgh Impact Study - Discussion Guide Other-Discussion Guide Unchanged
220379 DSW Report Form Unchanged
220378 FASD Core Training - 6 month follow-up Form Unchanged
220377 FASD Core Training Survey - Post-test Form Unchanged
220375 FASD Core Training Survey Pre-test Form and Instruction Modified
ICR Details
0920-1129 201707-0920-006
Historical Active 201704-0920-007
HHS/CDC 0920-1129 (17AUR)
Improving Fetal Alcohol Spectrum Disorders Prevention and Practice through Practice and Implementation Centers and National Partnerships
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved with change 07/27/2017
Retrieve Notice of Action (NOA) 07/21/2017
  Inventory as of this Action Requested Previously Approved
08/31/2019 08/31/2019 08/31/2019
31,577 0 31,577
3,748 0 3,764
0 0 0
Changes are being made to better align certain data collection instruments with the training strategies that are being implemented. Instruments are being changed to reduce burden on training participants, to address testing results that showed certain questions were not adequate for evaluation, to be more relevant to traiing target audiences, and to allow fo rthe provision of continuing education credit.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  80 FR 55362 09/15/2015
81 FR 11801 03/07/2016
Yes
50
IC Title Form No. Form Name
HIgh Impact Study - Discussion Guide
Pre-Training Survey (Nursing) none Nursing Pre-Training Survey
Six-Month Follow-Up Training Survey (Nursing) none Nursing Training Follow-up Survey
High Impact Study - Informant Interview
Nursing DSW Polling none Nursing DSW Polling
Nursing Organization Questionnaire nopne Nursing Organization Questionnaire
Nursing Network Survey none Nursing Network Survey
OBGYN Informant Interview - Posttraining none OBGYN Informant Interview - Posttraining
OBGYN Telecom Training Survey 0920-1129 OBGYN Telecom Training Satisfaction Survey (TTS)
Medical Assistants Pre-test Survey none Medical Assistants Pre-test Survey
Medical Assistants Post-test Survey none Medical Assistants Post-test Survey
Medical Assistants Follow-up Survey - Academic none Medical Assistants Folow-up Survey - Academic
AAP Pre-Training Evaluation Survey (Pediatrics) 0920-1129 Academia Americana De Pediatria Encuesta De Evaluacion De Seguimento De 6 Meses
AAP Post-Training Evaluation Survey (Pediatrics) 0920-1129 Academia Americana De Pediatria Ciiestionario De Elaluacion Posterior A La Capacitacion
FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation (previously NOFAS Pre-Test Survey) 0920-1129 FASD Prevention, Identification, & Alcohol Screening Pre-Training Evaluation
FASD Core Training Survey Pre-test 0920-1129 FASD Prevention, Identification & Alcohol Screening Pre-Training Evaluation
FASD Core Training Survey - Post-test none FASD Post-training survey
FASD Core Training - 6 month follow-up none FASD Training Survey - follow-up
Nursing Informant Interview
DSW Report none DSW Report
Pre-Training Survey (Nursing) none Nursing Post-training Survey
Healthcare Organization Survey none Healthcare Organization Survey
OBGYN Provider Skills Baseline none OBGYN Provider Skills Baseline
OBGYN Provider Follow-up none OBGYN Provider Follow-up
Social Work and Family Physician Post-training Survey none Social Work and Family Physician Post-training Survey
Social Work and Family Physician Follow-up Survey none Social Work and Family Physician Follow-up Survey
NOFAS Webinar Survey none NOFAS Webinar Survey
NOFAS Webinar 3 month Survey none NOFAS Webinar 3 month Survey
Clinical Process Improvement Survey none Clinical Process Improvement Survey
TCU Organizational Readiness Survey none TCU Organizational Readiness Survey
OBGYN Informant Interview - Pretraining none OBGYN Informant Interview - Pretraining
Medical Assistants Post-test Survey - Academic none Medical Assistants Post-test Survey - Academic
Medical Assistants Follow-up Survey none Medical Assistants Follow-up Survey
AAP 3 Month Follow-up Survey (Pediatrics) 0920-1129 AAP Three-month Follow-up Evaluation Survey
FASD Toolkit Focus Group Guide
FASD Work Plan none FASD Work Plan
FASD Training Evaluation none FASD Training Evaluation
Social Work and Family Physician Pre-training Survey none Social Work and Family Physician Pre-training Survey
FASD Prevention, Identification, & Alcohol Screening Post-Training Evaluation (previously NO FAS Post-Test Survey) 0920-1129 FASD Prevention, Identification, & Alcohol Screening Post-Training Evaluation
Organizational Readiness Survey none Organizational Readiness Survey
OBGYN Knowledge and Agency none OBGYN Knowledge and Agency
OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey) 0920-1129 OBGYN Guided Brief Intervention Satisfaction Survey
OBGYN Standardized Patient none OBGYN Standardized Patient
OBGYN FASD-SBI Training Event Evaluation 0920-1129 OBGYN FASD-SBI Training Event Evaluation
Medical Assistants Pre-test Survey - Academic none Medical Assistants Pre-test Survey - Academic
Medical Assistants Change in Practice Survey none Medical Assistants Change in Practice Survey
Pediatricians Survey none Survey of Pediatricians
AAP 6 Month Follow-up Evaluation Survey (Pediatrics) 0920-1129 AAP Six-Month Follow-Up Evaluation Survey
FASD Toolkit User Survey none FASD Toolkit User Survey
Family Medicine Evaluation none Family Medicine Evaluation
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 31,577 31,577 0 0 0 0
Annual Time Burden (Hours) 3,748 3,764 0 -16 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
These changes are being made to better align certain data collection instruments with the training strategies that are being implemented.
$1,603,724
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Thelma Sims 4046394771
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/21/2017