Performance Report

State Targeted Response to the Opioid Crisis Grant Program Reports

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.