Information Collection

HCPCS Alcohol and Drug Screening and Brief Intervention Survey

IC 185449 under ICR 200807-3201-001 · OMB 3201-0015.

Documents and Forms

Document Name Document Type
Form 1 HCPCS Alcohol and Drug Screening and Brief Intervention Survey Form and Instruction
1 HCPCS Alcohol and Drug Screening and Brief Intervention HCPCS Survey - Final - ROCIS submission -- June 2008.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	HCPCS Alcohol and Drug Screening and Brief Intervention Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	1	HCPCS Alcohol and Drug Screening and Brief Intervention Survey	HCPCS Survey - Final - ROCIS submission -- June 2008.doc		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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