Annual reporting - Plan Tool

MONITORING AND REPORTING SYSTEM FOR THE PRESCRIPTION DRUG OVERDOSE PREVENTION FOR STATES COOPERATIVE AGREEMENT

Documents and Forms

Document Name Document Type
Annual reporting - Plan Tool Form and Instruction
Annual reporting - Plan Tool Att. 3b Plan Tool.docm Form and Instruction

Information Collection (IC) Details

IC Title:	Annual reporting - Plan Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Annual reporting - Plan Tool	Att. 3b Plan Tool.docm	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 29	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	29	29
Annual IC Time Burden (Hours)	116	116
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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