Opioid Addiction Treatment ECHO, Virtual Learning Community – Satisfaction Survey

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0212 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Opioid Addiction Treatment ECHO, Virtual Learning Community – Satisfaction Survey Form
1 ECHO Survey.docx ECHO Survey.docx Form
ECHO Supporting Statement 10.10.17.docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Opioid Addiction Treatment ECHO, Virtual Learning Community – Satisfaction Survey	Agency IC Tracking Number:

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
Form	1	ECHO Survey.docx	ECHO Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	24	24
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	ECHO Supporting Statement 10.10.17.docx	10/19/2017

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