Clinician and Adolescent Feedback for the Development of an Adolescent Substance Use Continuing Medical Education/Continuing Education (CME/CE) Program

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIDA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0655 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Clinician and Adolescent Feedback for the Development of an Adolescent Substance Use Continuing Medical Education/Continuing Education (CME/CE) Program Form and Instruction
1 Clinician Survey 2 - Clinician Survey Screenshots.docx Form and Instruction
1 Pharmacist Survey 3 - Pharmacist Survey Screenshots.docx Form and Instruction
1 Adolescent Survey 4 - Adolescent Survey Screenshots.docx Form and Instruction
1 - OMB Application-Template 3-13-15_NIDAMED Fast Track Revised.doc Fast Track Submission Form IC Document
5 - Consent Forms (2)_3-5-15_NIDA revised.docx Consent Form IC Document

Information Collection (IC) Details

IC Title:	Clinician and Adolescent Feedback for the Development of an Adolescent Substance Use Continuing Medical Education/Continuing Education (CME/CE) Program	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Clinician Survey	2 - Clinician Survey Screenshots.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1	Pharmacist Survey	3 - Pharmacist Survey Screenshots.docx	Yes	Yes	Fillable Fileable
Form and Instruction	1	Adolescent Survey	4 - Adolescent Survey Screenshots.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,475	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,475	5,475
Annual IC Time Burden (Hours)	627	627
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Submission Form	1 - OMB Application-Template 3-13-15_NIDAMED Fast Track Revised.doc	03/16/2015
Consent Form	5 - Consent Forms (2)_3-5-15_NIDA revised.docx	03/16/2015

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