Information Collection

Website Usability Test for Division of Overdose Prevention Websites

IC 243063 under ICR 201902-0920-022 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.