Information Collection

Attitudes, Perceptions, and Behaviors of Individuals At-Risk for Prescription Opioid Misuse

IC 231327 under ICR 201608-0930-002 · OMB 0930-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Screening Protocol Attitudes, Perceptions, and Behaviors of Individuals At-Risk for Prescription Opioid Misuse	Form and Instruction
Screening Protocol Screening Protocol and Questionnaire 010820186015_CSAP Opioid TAB B_ Screening Protocol and Questionnaires_up....docx	Form and Instruction
010820186015_CSAP Opioid TAB A_Focus Group Protocol_update_APR27.docx Focus Group Protocol	IC Document
010820186015_CSAP Opioid TAB C_Consent and Confidentiality Forms_update_....docx Consent Forms	IC Document
010820186015_TAB D_Facilitator's Guide_update_APR27.docx Facilitator's Guide	IC Document
CSAP Opioid Summary Statement_update_APR27.docx Supporting Statement	IC Document
Revised TransLet-7doc.doc Transmittal Letter	IC Document

IC Title:

Attitudes, Perceptions, and Behaviors of Individuals At-Risk for Prescription Opioid Misuse

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 and Instruction	Screening Protocol and Questionnaire	Screening Protocol and Questionnaire	010820186015_CSAP Opioid TAB B_ Screening Protocol and Questionnaires_up....docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 108

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	108	108
Annual IC Time Burden (Hours)	122	122
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Focus Group Protocol	010820186015_CSAP Opioid TAB A_Focus Group Protocol_update_APR27.docx	05/03/2018
Consent Forms	010820186015_CSAP Opioid TAB C_Consent and Confidentiality Forms_update_....docx	05/03/2018
Facilitator's Guide	010820186015_TAB D_Facilitator's Guide_update_APR27.docx	05/03/2018
Supporting Statement	CSAP Opioid Summary Statement_update_APR27.docx	05/03/2018
Transmittal Letter	Revised TransLet-7doc.doc	05/03/2018

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