Information Collection

OBGYN Guided Brief Intervention Satisfactory Survey (previously OBGYN Avatar Training Satisfaction Survey)

IC 220396 under ICR 201707-0920-006 · OMB 0920-1129.

⚠️ Notice: This information collection may be referencing outdated material.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
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
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: Modified

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

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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	120	0	120
Annual IC Time Burden (Hours)	6	-4	10
Annual IC Cost Burden (Dollars)	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.