OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Preventing Adverse Childhood Experiences Pediatric Medical Provider Module Online Course

IC 237904 under ICR 201612-0920-007 · OMB 0920-1009.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Preventing Adverse Childhood Experiences Pediatric Medical Provider Module Online Course 0920-1009-19BSM
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1009 Course Evaluation Questions Att 1_Course Evaluation Questions.doc Yes Yes Fillable Fileable

Health Public Health Monitoring

 

4,500 0
   
State, Local, and Tribal Governments
 
   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 4,500 0 4,500 0 0 0
Annual IC Time Burden (Hours) 225 0 225 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
GenIC Request Template form 109_GenIC_Request_ACEs Pediatric Medical Provider Prevention Online Course_092419 (004).docx 09/27/2019
Privacy Assessment Att2_PIA Applicability.pdf 09/27/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.