Practitioner Survey

Screening, Brief Intervention, and Referral to Treatment (SBIRT) Cross-Site Evaluation

OMB: 0930-0321

IC ID: 195858

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

View Information Collection (IC)

Practitioner Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Practitioner Survey Practitioner Survey Attachment 2 Practitioner Survey.doc Yes Yes Paper Only

Health Public Health Monitoring

 

1,075 0
   
State, Local, and Tribal Governments
 
   100 %

  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 1,075 0 1,075 0 0 0
Annual IC Time Burden (Hours) 323 0 323 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Network Security Attachment 3 Network Security at RTI.doc 12/17/2010
Privacy Pledge Attachment 4 Privacy Pledge.doc 12/17/2010
Practitioner Informed Consent Attachment 5 Practitioner Informed Consent.doc 12/17/2010
Table Shell Attachment 6 Table Shell Descriptive Results.doc 12/17/2010
Evaluation Questions Attachment 1 Evaluation Questions 2011-03-21 (2).docx 03/22/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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