Form Approved
OMB No. 0902-1129
Exp.: 08/31/2019
Thank you for your interest in fetal alcohol spectrum disorders (FASD). We would like to invite you to complete an evaluation survey on the FASD Toolkit. We appreciate your willingness to help us evaluate the effectiveness of the toolkit and its impact on your practice as you address the prevention, identification, and treatment of FASD.

This survey will take approximately 15 minutes to complete. Your responses will be kept secure and no individually identifying information will be included. Risks to participating in this survey are minimal and include the risk of your information becoming known to individuals outside the AAP.

Your participation in this survey is voluntary. You may decline to answer any question and you have the right to stop the survey at any time.

Please submit questions to the project partners at

CDC estimates the average public reporting burden for this collection of information as 15 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN PRA (0920-1129).

* Please indicate your consent to participate in the survey by selecting one of the following choices:

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