Clinical End Users Recruiters

Evaluation of the SAMHSA PDMP Electronic Health Record Integration and Interoperability Expansion Program

Documents and Forms

Document Name Document Type
Attachment 10 - Clinical End Users Recruitment Material Templates - Final for ICRO.docx Instruction

Information Collection (IC) Details

IC Title:	Clinical End Users Recruiters	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Instruction			Attachment 10 - Clinical End Users Recruitment Material Templates - Final for ICRO.docx		No	No	Printable Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	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	20	20
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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