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Federal forms, ICRs, and supporting documents

Information Collection Request

Assessment of a Training Program to Improve Continuity of Care for Children and Families Affected by Fetal Alcohol Spectrum Disorders (FASD)

ICR 202107-0920-006 · OMB 0920-1347 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Resident Overall Program Assessment Form and Instruction New Repair queued
Resident Overall Effects & Prevalence Video Post-test Form and Instruction New Repair queued
Resident Overall Effects & Prevalence Video Pretest Form and Instruction New Repair queued
Attending Physicians Application Form and Instruction New Repair queued
Attending Physicians Debriefing Form and Instruction New Repair queued
Attending Physicians Overall Program Assessment Form and Instruction New Repair queued
Attending Physicians Training Program Assessment Form and Instruction New Repair queued
Attending Physicians Educational Care (post-test) Form and Instruction New Repair queued
Attending Physicians Educational Care (pre-test) Form and Instruction New Repair queued
Attending Physicians Overcoming Social Attitudes (post-test) Form and Instruction New Repair queued
Attending Physicians Overcoming Social Attitudes (pre-test) Form and Instruction New Repair queued
Attending Physicians Treatment Across the Lifespan (post-test) Form and Instruction New Repair queued
Attending Physicians Treatment Across the Lifespan (pre-test) Form and Instruction New Missing upstream
Attending Physicians Screening & Diagnosis (post-test) Form and Instruction New Repair queued
Attending Physicians Screening and Diagnosis (pre-test) Form and Instruction New Repair queued
SSA_AAP FASD Resident Training_07152021.docx Supporting Statement A Uploaded 2021-07-15 Missing upstream
A15b_recruiting materials.docx Supplementary Document Uploaded 2021-07-14 Repair queued
A16_60 day FRN_published 03082021.pdf Supplementary Document Uploaded 2021-07-14 Repair queued
A17 Section 301 of the Public Health Service Act_0920-1129.docx Supplementary Document Uploaded 2021-07-14 Missing upstream
SSB_AAP FASD Resident Training_07142021.docx Supporting Statement B Uploaded 2021-07-14 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
248410 Resident Overall Program Assessment Form and Instruction New
248409 Resident Overall Effects & Prevalence Video Post-test Form and Instruction New
248408 Resident Overall Effects & Prevalence Video Pretest Form and Instruction New
248407 Attending Physicians Application Form and Instruction New
248406 Attending Physicians Debriefing Form and Instruction New
248405 Attending Physicians Overall Program Assessment Form and Instruction New
248404 Attending Physicians Training Program Assessment Form and Instruction New
248402 Attending Physicians Educational Care (post-test) Form and Instruction New
248401 Attending Physicians Educational Care (pre-test) Form and Instruction New
248400 Attending Physicians Overcoming Social Attitudes (post-test) Form and Instruction New
248399 Attending Physicians Overcoming Social Attitudes (pre-test) Form and Instruction New
248398 Attending Physicians Treatment Across the Lifespan (post-test) Form and Instruction New
248397 Attending Physicians Treatment Across the Lifespan (pre-test) Form and Instruction New
248393 Attending Physicians Screening & Diagnosis (post-test) Form and Instruction New
248377 Attending Physicians Screening and Diagnosis (pre-test) Form and Instruction New
ICR Details
202107-0920-006
Received in OIRA
HHS/CDC 0920-21DJ
Assessment of a Training Program to Improve Continuity of Care for Children and Families Affected by Fetal Alcohol Spectrum Disorders (FASD)
New collection (Request for a new OMB Control Number)   No
Regular 07/19/2021
  Requested Previously Approved
36 Months From Approved
870 0
223 0
19,375 0
The purpose of this data collection is to evaluate a newly developed pediatric resident training curriculum regarding identification, referral and care of children with fetal alcohol spectrum disorders (FASD) and their families. Information will be collected by the American Academy of Pediatrics (AAP) staff through paper-and-pencil surveys for in-person training of attending physicians and by a secure online platform (Qualtrics) for resident trainees as well as the overall program evaluations for attending physicians. Attending physicians will also be asked to participate in a final project debriefing conference call. The overall objective of the training program is to improve recognition, diagnosis and treatment for children with FASD to improve their developmental, cognitive and educational outcomes.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  86 FR 13391 03/08/2021
86 FR 38101 07/19/2021
No
15
IC Title Form No. Form Name
Attending Physicians Application n/a Application Survey for the Improving Continuity of Care for Children and Families Affected by Prenatal Alcohol Exposure
Attending Physicians Debriefing n/a Attending Physician Debrief Questionnaire - Facilitator Guide
Attending Physicians Educational Care (post-test) n/a Educational Care for Children Affected by Prenatal Alcohol Exposure (post-training evaluation survey)
Attending Physicians Educational Care (pre-test) n/a Educational Care for Children Affected by Prenatal Alcohol Exposure (pre-training evaluation survey)
Attending Physicians Overall Program Assessment n/a FASD Precepting Attending Program Evaluation
Attending Physicians Overcoming Social Attitudes (post-test) n/a Overcoming Social Attitudes as a Barrier to Early Identification of FASD (post-training evaluation survey)
Attending Physicians Overcoming Social Attitudes (pre-test) n/a Overcoming Social Attitudes as a Barrier to Early Identification of FASD (pre-training evaluation survey)
Attending Physicians Screening & Diagnosis (post-test) n/a FASD: Screening, Assessment, & Diagnosis (post-training evaluation survey)
Attending Physicians Screening and Diagnosis (pre-test) n/a FASD: Screening, Assessment, & Diagnosis (pre-training evaluation survey)
Attending Physicians Training Program Assessment n/a FASD Train the Trainer Session Evaluation
Attending Physicians Treatment Across the Lifespan (post-test) n/a Treatment Across the Lifespan for Persons with FASD (post-training evaluation survey)
Attending Physicians Treatment Across the Lifespan (pre-test) n/a Treatment Across the Lifespan for Persons with FASD (pre-training evaluation survey)
Resident Overall Effects & Prevalence Video Post-test n/a Post-training Evaluation Survey
Resident Overall Effects & Prevalence Video Pretest n/a Pre-training Evaluation Survey
Resident Overall Program Assessment n/a Resident-Trainee Overall Program Evaluation
  Total Request 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 870 0 0 870 0 0
Annual Time Burden (Hours) 223 0 0 223 0 0
Annual Cost Burden (Dollars) 19,375 0 0 19,375 0 0
Yes
Miscellaneous Actions
No
This is a new, one-time information collection request.
$97,804
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Renita Macaluso 770 488-6458 [email protected]
  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.
07/19/2021