Information Collection

Pharmacy SOPS Database Data Use Agreement

IC 211068 under ICR 201403-0935-003 · OMB 0935-0218.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0218 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Pharmacy SOPS Database Data Use Agreement	Form and Instruction
3 Pharmacy SOPS Database Data Use Agreement Attachment C - Pharmacy SOPS Data Use Agreement 03-18-14docx.docx	Form and Instruction

IC Title:

Pharmacy SOPS Database Data Use Agreement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	Pharmacy SOPS Database Data Use Agreement	Attachment C - Pharmacy SOPS Data Use Agreement 03-18-14docx.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.