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

Pretesting of Substance Abuse Prevention and Treatment and Mental Health Services Communications Messages

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.