State Survey - Baseline

State Targeted Response to the Opioid Crisis (Opioid STR) Evaluation

OMB: 0930-0379

IC ID: 227371

Information Collection (IC) Details

View Information Collection (IC)

State Survey - Baseline
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction State Director Baseline Survey State Director Baseline Survey Attachment 1. Opioid STR State Director Baseline Survey 7.5.17.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

57 0
   
State, Local, and Tribal Governments
 
   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 57 0 57 0 0 0
Annual IC Time Burden (Hours) 228 0 228 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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