Prescribers

Surgeon General’s Pledge to Stem the Opioid Epidemic

Documents and Forms

Document Name Document Type
SSA_OSG_Opioid_Attachment 2_Final.docx Other-survey
SSA_OSG_Opioid_Attachment 1_Final.docx Other-survey
SSA_OSG_Opioid_Attachment 2_Final.docx Other-survey

Information Collection (IC) Details

IC Title:	Prescribers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey	SSA_OSG_Opioid_Attachment 2_Final.docx	Yes	Yes	Fillable Fileable
Other-survey	SSA_OSG_Opioid_Attachment 1_Final.docx	Yes	No	Fillable Fileable
Other-survey	SSA_OSG_Opioid_Attachment 2_Final.docx	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18,000	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	18,000	8,000	10,000
Annual IC Time Burden (Hours)	1,200	533	667
Annual IC Cost Burden (Dollars)	0	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.