Prescription Drug Overdose Prevention for States Program Assessment

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Attachment C_Instrument- Telephone Interview Guide.docx Other-Interview Guide
PFS-EVAL-SSA.DOCX Supporting Statement A IC Document
PFS-EVAL-SSB.docx Supporting Statement B IC Document
Attachment A_List of PfS Awardees.docx List of Awardees IC Document
Attachment B_PfS Strategies and Activities.docx Strategies and Activities IC Document
Attachment D_Recruitment E-mail.docx Recruitment Email IC Document
Attachment E_Reminder E-mail.docx Reminder Email IC Document
Attachment F_Confirmation E-mail.docx Confirmation Email IC Document
Attachment G_Follow-up E-mail.docx Follow-up Email IC Document

Information Collection (IC) Details

IC Title:	Prescription Drug Overdose Prevention for States Program Assessment	Agency IC Tracking Number:	0920-0879-18FK

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
Other-Interview Guide			Attachment C_Instrument- Telephone Interview Guide.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 87	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	87	87
Annual IC Time Burden (Hours)	174	174
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	PFS-EVAL-SSA.DOCX	11/13/2017
Supporting Statement B	PFS-EVAL-SSB.docx	11/13/2017
List of Awardees	Attachment A_List of PfS Awardees.docx	11/13/2017
Strategies and Activities	Attachment B_PfS Strategies and Activities.docx	11/13/2017
Recruitment Email	Attachment D_Recruitment E-mail.docx	11/13/2017
Reminder Email	Attachment E_Reminder E-mail.docx	11/13/2017
Confirmation Email	Attachment F_Confirmation E-mail.docx	11/13/2017
Follow-up Email	Attachment G_Follow-up E-mail.docx	11/13/2017

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