View Information Collection (IC)
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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 Attachment B-HCP QualBoard Screener-MD-NP-PA-MW Attachment B-HCP QualBoard Screener-MD-NP-PA-MW.docx Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Attachment L-HCP QualBoard Discussion Guide Attachment L-HCP QualBoard Discussion Guide.docx Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Attachment E-HCP IDI Screener-RN-MA Attachment E-HCP IDI Screener-RN-MA.docx Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Attachment E-HCP IDI Discussion Guide -RN-MA Attachment N-HCP IDI DIscussion Guide.docx Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Attachment F-WRA QualBoard Screener Attachment F-WRA QualBoard Screener.docx Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Attachment F-WRA QualBoard Discussion Board Attachment M-WRA QualBoard Discussion Guide.docx Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Attachment G-WRA Focus Group Screener Attachment G-WRA Focus Group Screener.docx Yes Yes Fillable Fileable
Form and Instruction 0920-21FM Attachment O-WRA Focus Group Discussion Guide Attachment O-WRA Focus Group Discussion Guide.docx 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 Attachment S-Burden Hour Calculations.docx 06/21/2021
Attachment R-IRB Determination Attachment R-IRB Determination.pdf 06/21/2021
Attachment Q-WRA Materials Attachment Q-WRA Materials.pdf 06/21/2021
Attachment P-HCP Materials Attachment P-HCP Materials.pdf 06/21/2021
Attachment N-HCP IDI DIscussion Guide Attachment N-HCP IDI DIscussion Guide.docx 06/21/2021
Attachment A-Message Testing Plan Attachment A-Message Testing Plan.docx 06/21/2021
Attachment K-Info-WRA Focus Group Participants Attachment K-Info-WRA Focus Group Participants.docx 06/21/2021
Attachment J-Info-HCP IDI Participants Attachment J-Info-HCP IDI Participants.docx 06/21/2021
Attachment I-Info-WRA QualBoard Participants Attachment I-Info-WRA QualBoard Participants.docx 06/21/2021
Attachment H-Info-HCP QualBoard Participants Attachment H-Info-HCP QualBoard Participants.docx 06/21/2021
_List of Attachments _List of Attachments.docx 06/21/2021
HMTSExpeditedReviewForm HMTSExpeditedReviewForm.pdf 06/21/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.