Physicians

Online Skills Training for PCPs on Substance Abuse (NIDA)

Documents and Forms

Document Name Document Type
Form 1 Physicians Form and Instruction
1 Screener N44DA-9-2214Attachment3ScreeningTool_March2011.doc Form and Instruction
2 Assessment N44DA-9-2214-Attachment5AssessmentForms_March2011.doc Form and Instruction
N44DA-9-2214-Attachment4InitialContact_March2011.doc N44DA-9-2214-Attachment4InitialContact_March2011 IC Document

Information Collection (IC) Details

IC Title:	Physicians	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Screener	N44DA-9-2214Attachment3ScreeningTool_March2011.doc		Yes	Yes	Fillable Fileable
Form and Instruction	2	Assessment	N44DA-9-2214-Attachment5AssessmentForms_March2011.doc		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
N44DA-9-2214-Attachment4InitialContact_March2011	N44DA-9-2214-Attachment4InitialContact_March2011.doc	04/04/2011

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