MEDICAL RESPONSIBILITY STATEMENT FOR USE OF METHADONE IN A TREATMENT PROGRAM

ICR 197810-0910-003

OMB: 0910-0042

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0910-0042 197810-0910-003
Historical Active 197802-0910-003
HHS/FDA
MEDICAL RESPONSIBILITY STATEMENT FOR USE OF METHADONE IN A TREATMENT PROGRAM
Extension without change of a currently approved collection   No
Regular
Approved without change 11/21/1978
Retrieve Notice of Action (NOA) 10/31/1978
  Inventory as of this Action Requested Previously Approved
07/31/1979 07/31/1979 12/31/1978
200 0 200
100 0 100
0 0 0



None
None


No

1
IC Title Form No. Form Name
MEDICAL RESPONSIBILITY STATEMENT FOR USE OF METHADONE IN A TREATMENT PROGRAM FD-2633

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 200 200 0 0 0 0
Annual Time Burden (Hours) 100 100 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/31/1978


© 2024 OMB.report | Privacy Policy