Adverse Health Effects Associated with Synthetic Cannabinoid Use - Mississippi, 2015

Emergency Epidemic Investigation Data Collections - Expedited Reviews

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Document Name Document Type
Adverse Health Effects Associated with Synthetic Cannabinoid Use - Mississippi, 2015 Form
Synthetic Cannabinoid Use - Medical Records Abstraction Appendix1_medical abstraction form.docx Form
Synthetic Cannabinoid Use - Patient (or Surrogate) Inter Appendix2_Patient Interview Questionnaire.docx Form
0920-1011 Marijuana_MS.docx Request for GenIC Approval IC Document
MS_Epi AID Request 4 23 15.pdf MS Epi-Aid Request - LOI IC Document
FW URGENT 0920-1011 GenIC Request 2015007-XXX Marijuana_MS.msg Urgent GenIC Request - email w/ Burden Table IC Document

Information Collection (IC) Details

IC Title:	Adverse Health Effects Associated with Synthetic Cannabinoid Use - Mississippi, 2015	Agency IC Tracking Number:	0920-1011

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	None	Synthetic Cannabinoid Use - Medical Records Abstraction Form	Appendix1_medical abstraction form.docx	None	No		Paper Only
Form	None	Synthetic Cannabinoid Use - Patient (or Surrogate) Interview	Appendix2_Patient Interview Questionnaire.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Epidemic Investigation Case Records	FR Citation: 51 FR 4246

Number of Respondents: 430	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	430	430
Annual IC Time Burden (Hours)	426	426
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for GenIC Approval	0920-1011 Marijuana_MS.docx	04/24/2015
MS Epi-Aid Request - LOI	MS_Epi AID Request 4 23 15.pdf	04/24/2015
Urgent GenIC Request - email w/ Burden Table	FW URGENT 0920-1011 GenIC Request 2015007-XXX Marijuana_MS.msg	04/24/2015

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