Information Collection

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

IC 7645 under ICR 201204-0930-001 · OMB 0930-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0234 can be found here:

Documents and Forms

Document Name Document Type
Form Attachment B - SMA Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction Form and Instruction
Attachment B - SMA Attachment B - SMA-167 TAB B-SMA-167_Increase_Patients-07-19-12.pdf Form and Instruction
AttachmentC.wpd Interagency Workgroup on Implementation DAT Act of 2000 IC Document
AttachmentA.wpd Drug Addiction Treatment Act 2000 IC Document
Attachment-D.pdf Privacy Act Documents IC Document
Attachment-E.doc Physician Response Letters IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction	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	Attachment B - SMA-167	Attachment B - SMA-167	TAB B-SMA-167_Increase_Patients-07-19-12.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,050	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,050	2,050
Annual IC Time Burden (Hours)	149	149
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.