Information Collection

Rowan University School of Osteopathic Medicine (SOM)

IC 232576 under ICR 201708-0990-001 · OMB 0990-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Opioid Prescribing Presentation Pre Assessment_ Qualtrics_Medical Students_Final.docx.pdf	Other-PRE Assessment
Opioid Prescribing Presentation Satisfaction Survey_Residents.docx	Other-Satisfaction Survey
Opioid Prescribing Presentation Satisfaction Survey_Medical Students.docx	Other-Satisfaction for Medical stude
Opioid Prescribing Presentation Post Assessment_Residents.docx	Other-Post Assessment
Opioid Prescribing Presentation Post Assessment_Medical Students.docx	Other-Assessment Medical Students
Opioid Prescribing Presentation Pre Assessment_Residents.docx	Other-Pre Assessment Residents
Opioid Prescribing Presentation Pre Assessment_Medical Students.docx	Other-Pre-Assessment Medical Student
Opioid Prescribing Presentation Pre Assessment_ Qualtrics_Medical Students_Final.docx.pdf	Other-Qualtrics
OMB_Clearance_Submission_Form_OWHPA - Rowan Univ. SOM.doc SS_A	IC Document

IC Title:

Rowan University School of Osteopathic Medicine (SOM)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Electronic Capability
Other-PRE Assessment	Opioid Prescribing Presentation Pre Assessment_ Qualtrics_Medical Students_Final.docx.pdf		No	Paper Only
Other-Satisfaction Survey	Opioid Prescribing Presentation Satisfaction Survey_Residents.docx		No	Paper Only
Other-Satisfaction for Medical students	Opioid Prescribing Presentation Satisfaction Survey_Medical Students.docx		No	Paper Only
Other-Post Assessment	Opioid Prescribing Presentation Post Assessment_Residents.docx		No	Paper Only
Other-Assessment Medical Students	Opioid Prescribing Presentation Post Assessment_Medical Students.docx		No	Fillable Printable
Other-Pre Assessment Residents	Opioid Prescribing Presentation Pre Assessment_Residents.docx	Pre -Assessment Residents	No	Paper Only
Other-Pre-Assessment Medical Students	Opioid Prescribing Presentation Pre Assessment_Medical Students.docx		No	Paper Only
Other-Qualtrics	Opioid Prescribing Presentation Pre Assessment_ Qualtrics_Medical Students_Final.docx.pdf		No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SS_A	OMB_Clearance_Submission_Form_OWHPA - Rowan Univ. SOM.doc	08/07/2018

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