Information Collection

HCPCS Alcohol and Drug Screening and Brief Intervention Survey

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.