Information Collection

Study of Bh-Works

IC 222402 under ICR 201503-0925-007 · OMB 0925-0655.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Study of Bh-Works	Form
1 Utility and Usability test Attachment 1 Utility and Usability test - NIDA 07112016.pdf	Form
2 Questionnaire Focus group Attachment 3 - Questionnaire Focus Group- NIDA 0629.docx	Form
Fast Track Template mdlogix BH-Works Field Study-NIDA 070816 (002).doc Fast Track template mdlogix BH-Works Field Study	IC Document

IC Title:

Study of Bh-Works

Agency IC Tracking Number:

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	1	Utility and Usability test	Attachment 1 Utility and Usability test - NIDA 07112016.pdf		Yes	Yes	Fillable Fileable
Form	2	Questionnaire Focus group	Attachment 3 - Questionnaire Focus Group- NIDA 0629.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track template mdlogix BH-Works Field Study	Fast Track Template mdlogix BH-Works Field Study-NIDA 070816 (002).doc	07/11/2016

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