Information Collection

Request for Opioid Project Information from Patient Safety Organizations (PSOs)

IC 232977 under ICR 201709-0935-001 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Request for Opioid Project Information from Patient Safety Organizations (PSOs)	Form and Instruction
1 Request for Opioid Project Information FINAL Request for Opioid Project Info 9.10.18 (002).docx	Form and Instruction
Fast Track AHRQ PSO Opioid Summit.docx Supporting Statement	IC Document
Cover Page.doc Cover Letter	IC Document

IC Title:

Request for Opioid Project Information from Patient Safety Organizations (PSOs)

Agency IC Tracking Number:

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
Form and Instruction	1	Request for Opioid Project Information	FINAL Request for Opioid Project Info 9.10.18 (002).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	40	40
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Fast Track AHRQ PSO Opioid Summit.docx	09/11/2018
Cover Letter	Cover Page.doc	09/11/2018

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