OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medication-Assisted Treatment (MAT) Providers & PrEP Providers Survey

IC 235443 under ICR 201804-0917-001 · OMB 0917-0036.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Medication-Assisted Treatment (MAT) Providers & PrEP Providers Survey 87
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 87 MAT Provider Survey MAT Provider Survey Draft 3-18-19.docx Yes Yes Fillable Fileable
Form and Instruction 87-1 PrEP Questionnaire PrEP Questionnaire Draft 3-18-19.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

125 0
   
Federal Government
 
   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 125 0 125 0 0 0
Annual IC Time Burden (Hours) 19 0 19 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
MAT-PrEP Provider Surveys 2015 Clearance Submission Template - MAT-PrEP Provider Surveys.doc 03/21/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.