Otp

Opioid Treatment Program (OTP) Mortality Reporting Form

Documents and Forms

Document Name Document Type
Form OTP Mortality Repo OTP Form and Instruction
OTP Mortality Repo Attachment C - OTP Mortality Reporting Form Attachment C.doc Form and Instruction
Attachment A.doc Attachment A - Public Comments IC Document
Attachment B.doc Attachment B - Letter IC Document
Attachment D.doc Attachment D - Fax Instructions IC Document
Attachment E.doc Attachment E - Online Instructions IC Document

Information Collection (IC) Details

IC Title:	OTP	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	OTP Mortality Reporting Form	Attachment C - OTP Mortality Reporting Form	Attachment C.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,150	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,300	2,300
Annual IC Time Burden (Hours)	1,150	1,150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment A - Public Comments	Attachment A.doc	05/15/2008
Attachment B - Letter	Attachment B.doc	05/15/2008
Attachment D - Fax Instructions	Attachment D.doc	05/15/2008
Attachment E - Online Instructions	Attachment E.doc	05/15/2008

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