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Information Collection

Hospital Request For Methadone For Detoxification And Temporary Maintenance Treatment

IC 109461 under ICR 197801-0910-002 · OMB 0910-0044.

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Information Collection (IC) Details

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HOSPITAL REQUEST FOR METHADONE FOR DETOXIFICATION AND TEMPORARY MAINTENANCE TREATMENT
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form FD-2636 No No


    

24 0
   
Private Sector Businesses or other for-profits
 
   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 25 0 0 25 0 0
Annual IC Time Burden (Hours) 13 0 0 13 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.