OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Prescription Monitoring Program Questionnaire

IC 12344 under ICR 200902-1117-002 · OMB 1117-0037.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Prescription Monitoring Program Questionnaire
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction OMB Number 1117-0037 Prescription Monitoring Program Questionnaire questionnaire prescription monitoring program- 040109.doc Yes Yes Fillable Fileable Signable

Law Enforcement Substance Control

 

51 0
   
State, Local, and Tribal Governments
 
   50 %

  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 51 0 0 0 0 51
Annual IC Time Burden (Hours) 255 0 0 0 0 255
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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