Website Usability Test for Division of Overdose Prevention Websites

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1050 Website Usability Test for Division of Overdose Prevention Websites Form and Instruction
0920-1050 Individual Screener Att. 2 Individuals_Screen.docx Form and Instruction
0920-1050 Individual - Rx Awareness Moderator Guide Att. 4 _Rx Awareness_Moderator Guide_07212020.docx Form and Instruction
0920-1050 Individual - Marijuana Moderator Guide Att. 5 Marijuana_Moderator Guide_07212020.docx Form and Instruction
0920-1050 Healthcare Provider Screener Att. 3 Providers_Screen.docx Form and Instruction
0920-1050 Healthcare Provider - Drug Overdose Moderator Guide Att. 7 Drug Overdose _Providers_Moderator Guide_07212020.docx Form and Instruction
0920-1050 Healthcare Provider - Acute Pain Moderator Guide Att. 6 Acute Pain_Moderator Guide_07212020.docx Form and Instruction
Att. 1 Privacy Applicability.pdf Privacy Applicability IC Document
Att. 8_Consent Form.docx Website Usability Consent (Public / Healthcare Provider) IC Document
1050_DOP_Website_Usability_.docx GenIC Request - Website Usability IC Document

Information Collection (IC) Details

IC Title:	Website Usability Test for Division of Overdose Prevention Websites	Agency IC Tracking Number:	0920-1050-20QY

IC Status: New

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	0920-1050	Individual - Rx Awareness Moderator Guide	Att. 4 _Rx Awareness_Moderator Guide_07212020.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Individual - Marijuana Moderator Guide	Att. 5 Marijuana_Moderator Guide_07212020.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Healthcare Provider Screener	Att. 3 Providers_Screen.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Healthcare Provider - Drug Overdose Moderator Guide	Att. 7 Drug Overdose _Providers_Moderator Guide_07212020.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Healthcare Provider - Acute Pain Moderator Guide	Att. 6 Acute Pain_Moderator Guide_07212020.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Individual Screener	Att. 2 Individuals_Screen.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 108	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	108	108
Annual IC Time Burden (Hours)	34	34
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Privacy Applicability	Att. 1 Privacy Applicability.pdf	08/07/2020
Website Usability Consent (Public / Healthcare Provider)	Att. 8_Consent Form.docx	08/07/2020
GenIC Request - Website Usability	1050_DOP_Website_Usability_.docx	08/07/2020

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