Addressing the Opioid Crisis in Communities of Color

ASPE Generic Clearance for the Collection of Qualitative Research and Assessment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Document Name Document Type
0990-0421 Generic - Attach A _Discussion Guide_Addressing the Opioid Crisis in Communities of Color_FINAL_OMB 03092020.docx Other-discussion guide
0990-0421 Generic - Attachment B_Small Group Discussion Guide_Addressing the Opioid Crisis in Communities of Color_FINAL_OMB 030 Other-Discussion Guide
0990-0421 Generic Attachment C_Script for Verbal Consent_OUD and communities of color_March 12 2020.docx Other-Consent form
0990-0421 Generic - CoverSheet_Addressing the Opioid Crisis in Communities of Color_FINAL.docx coversheet IC Document
0990-0421 Generic - SupportingStatement A_Addressing the Opioid Crisis in Communities of Color_FINAL_OMB 03092020.docx SS-A IC Document
0990-0421 Generic - SupportingStatement B_Addressing the Opioid Crisis in Communities of Color_FINAL.docx SS-B IC Document

Information Collection (IC) Details

IC Title:	Addressing the Opioid Crisis in Communities of Color	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Consent form	0990-0421 Generic Attachment C_Script for Verbal Consent_OUD and communities of color_March 12 2020.docx	No	Paper Only
Other-discussion guide	0990-0421 Generic - Attach A _Discussion Guide_Addressing the Opioid Crisis in Communities of Color_FINAL_OMB 03092020.docx	No	Paper Only
Other-Discussion Guide	0990-0421 Generic - Attachment B_Small Group Discussion Guide_Addressing the Opioid Crisis in Communities of Color_FINAL_OMB 03092020.docx	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 64	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	64	64
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
coversheet	0990-0421 Generic - CoverSheet_Addressing the Opioid Crisis in Communities of Color_FINAL.docx	01/14/2020
SS-A	0990-0421 Generic - SupportingStatement A_Addressing the Opioid Crisis in Communities of Color_FINAL_OMB 03092020.docx	03/13/2020
SS-B	0990-0421 Generic - SupportingStatement B_Addressing the Opioid Crisis in Communities of Color_FINAL.docx	01/14/2020

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