Performance Report

State Targeted Response to the Opioid Crisis Grant Program Reports

Documents and Forms

Document Name Document Type
Form Tables A-E Performance Report Form and Instruction
Tables A-E Tables A-E Attachments_A_E IV-tables.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Performance Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Tables A-E	Tables A-E	Attachments_A_E IV-tables.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	114	0	114
Annual IC Time Burden (Hours)	969	57	912
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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