Information Collection

Performance Report

IC 227370 under ICR 201707-0930-002 · OMB 0930-0378.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0378 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment_B_Opioid_STR_Recipient_Comment.pdf Comment	IC Document
Attachment_C_SAMHSA_Response_to_Opioid_STR_Comment.pdf Response	IC Document

IC Title:

Performance Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	114	114
Annual IC Time Burden (Hours)	912	912
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Comment	Attachment_B_Opioid_STR_Recipient_Comment.pdf	07/06/2017
Response	Attachment_C_SAMHSA_Response_to_Opioid_STR_Comment.pdf	07/06/2017

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