NP PA NOI Form

Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction by a “Qualifying Other Practitioner"

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.