Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction

Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction

OMB: 0930-0234

IC ID: 7645

Information Collection (IC) Details

View Information Collection (IC)

Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Attachment B - SMA-167 Attachment B - SMA-167 TAB B-SMA-167_Increase_Patients-07-19-12.pdf Yes Yes Paper Only

Health Public Health Monitoring

 

2,050 0
   
Private Sector Businesses or other for-profits
 
   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 2,050 0 0 0 0 2,050
Annual IC Time Burden (Hours) 149 0 0 0 0 149
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Interagency Workgroup on Implementation DAT Act of 2000 AttachmentC.wpd 02/26/2009
Drug Addiction Treatment Act 2000 AttachmentA.wpd 02/26/2009
Privacy Act Documents Attachment-D.pdf 02/26/2009
Physician Response Letters Attachment-E.doc 04/12/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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