Information Collection

NP PA NOI Form

IC 224651 under ICR 201705-0930-005 · OMB 0930-0369.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Qualifying Other P NP PA NOI Form	Form and Instruction
Qualifying Other P Qualifying Other Practitioner NOI A-Qualifying Other Practitioner NOI 5 31 2017 imr FINAL.doc	Form and Instruction
B-Letters received related to NP and PA NOI.pdf Comments	IC Document
C-SAMHSA Comments Disposition Table 5.31.2017.xlsx Responses	IC Document

IC Title:

NP PA NOI Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Qualifying Other Practitioner NOI	Qualifying Other Practitioner NOI	A-Qualifying Other Practitioner NOI 5 31 2017 imr FINAL.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,406

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,406	1,406
Annual IC Time Burden (Hours)	93	93
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Comments	B-Letters received related to NP and PA NOI.pdf	06/01/2017
Responses	C-SAMHSA Comments Disposition Table 5.31.2017.xlsx	06/01/2017

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