Substitue Data Request Form

Strategic Prevention Framework for Prescription Drugs (SPF-Rx)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0377 can be found here:

Documents and Forms

Document Name Document Type
Form Substitue Data Req Substitue Data Request Form Form and Instruction
Substitue Data Req Substitue Data Request Form Attachment_5_SPF-Rx_SubstDataFormOMB_OMB_06_19_17.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Substitue Data Request Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Substitue Data Request Form	Substitue Data Request Form	Attachment_5_SPF-Rx_SubstDataFormOMB_OMB_06_19_17.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	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.