View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Message Testing to Improve Patient-Provider Communication on the Risks of Alcohol Use during Pregnancy 0920-21FM
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 092-21FM Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Yes Yes Fillable Fileable

Health Consumer Health and Safety

 

416 0
   
Individuals or Households
 
   0 %

  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 416 0 416 0 0 0
Annual IC Time Burden (Hours) 283 0 283 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Burden Calculations 06/21/2021
Attachment R-IRB Determination 06/21/2021
Attachment Q-WRA Materials 06/21/2021
Attachment P-HCP Materials 06/21/2021
Attachment N-HCP IDI DIscussion Guide 06/21/2021
Attachment A-Message Testing Plan 06/21/2021
Attachment K-Info-WRA Focus Group Participants 06/21/2021
Attachment J-Info-HCP IDI Participants 06/21/2021
Attachment I-Info-WRA QualBoard Participants 06/21/2021
Attachment H-Info-HCP QualBoard Participants 06/21/2021
_List of Attachments 06/21/2021
HMTSExpeditedReviewForm 06/21/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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