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Federal forms, ICRs, and supporting documents

Information Collection

NP PA NOI Form

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

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
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NP PA NOI Form
 
No Modified
 
Voluntary
 

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

Health Public Health Monitoring

 

1,406 0
   
Individuals or Households
 
   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 1,406 0 0 0 0 1,406
Annual IC Time Burden (Hours) 93 0 0 0 0 93
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.