Client questionnaire - 24 month follow-up

Evaluation of Medication- Assisted Treatment (MAT) for Opioid Use Disorders Study

OMB: 0920-1218

IC ID: 228979

Information Collection (IC) Details

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Client questionnaire - 24 month follow-up
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Client questionnaire - 24 month follow-up - Spanish Attachment 6 Client Questionnaire baseline 12 24 months__09_27_17_spanish.docx Yes Yes Fillable Fileable
Form none Client questionnaire - 24 month follow-up - English Attachment 6 Client Questionnaire baseline 12 24 months_9_27_17 17ACE_MAT.docx Yes Yes Fillable Fileable

Health Health Care Services

Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

744 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 744 0 744 0 0 0
Annual IC Time Burden (Hours) 558 0 558 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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