Information Collection

Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits

IC 230847 under ICR 201804-0917-001 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0036 Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits	Form and Instruction
0917-0036 Evaluation Survey IHS DBH OpioidRxEvaluation Survey March 15 2018.docx	Form and Instruction
IHS DBH Generic Clearance Submission March 15 2018.doc DBH Clearance Submission for Evaluation Survey	IC Document

IC Title:

Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits

Agency IC Tracking Number:

IC Status: Unchanged

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	0917-0036	Evaluation Survey	IHS DBH OpioidRxEvaluation Survey March 15 2018.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 125

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DBH Clearance Submission for Evaluation Survey	IHS DBH Generic Clearance Submission March 15 2018.doc	03/28/2018

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