Request for a Temporary Patient Increase Patient Increase for an Emergency

Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction

OMB: 0930-0234

IC ID: 222817

Documents and Forms
Document Name
Document Type
Instruction
Information Collection (IC) Details

View Information Collection (IC)

Request for a Temporary Patient Increase Patient Increase for an Emergency
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction No Form.doc Yes Yes Fillable Printable

Health Public Health Monitoring

 

10 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 10 0 0 0 0 10
Annual IC Time Burden (Hours) 30 0 0 0 0 30
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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