Information Collection

Study of Bh-Works

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Study of Bh-Works	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	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 %

	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

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.