Client-level Data for Community Program Level - Follow-up

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

Documents and Forms

Document Name Document Type
Form GPRA Client Outcom Client-level Data for Community Program Level - Follow-up Form and Instruction
GPRA Client Outcom GPRA Client Outcome Measures Tool Attachment 15 CSAT_GPRA Client Outcome Measures Tool.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Client-level Data for Community Program Level - Follow-up	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	GPRA Client Outcome Measures Tool	GPRA Client Outcome Measures Tool	Attachment 15 CSAT_GPRA Client Outcome Measures Tool.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 800	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	800	800
Annual IC Time Burden (Hours)	416	416
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.