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Ethnicity & Race: Messaging to Improve Patient-Provider Communication and Engagement on Risks of Alcohol Use During Pregnancy 0920-1154-19AUM
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1154 Yes Yes Fillable Fileable
Form and Instruction 0920-1154 No   Paper Only
Form and Instruction 0920-1154 No   Fillable Fileable Signable
Form 0920-1154 Yes Yes Fillable Fileable
Other-Screenshots No   Paper Only
Other-WORD No   Paper Only
Instruction Yes No Printable Only
Other-WORD No   Printable Only
Other-Screenshots No   Paper Only
Other-Screenshots No   Printable Only

Health Health Care Services

 

900 0
   
Private Sector Businesses or other for-profits
 
   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 900 0 900 0 0 0
Annual IC Time Burden (Hours) 307 0 307 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att L_IRB 05/07/2019
Supporting Statement A 05/07/2019
Supporting Statement B 05/07/2019
Request for Approval 05/07/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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