Notice to Treat up to 275 Patients

Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction

OMB: 0930-0234

IC ID: 222812

Information Collection (IC) Details

View Information Collection (IC)

Notice to Treat up to 275 Patients
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Waiver Form 275 patients Waiver Form 275 patients Attachment C NOI 275 Waiver 9.16.19.doc Yes Yes Fillable Fileable

Health Public Health Monitoring

 

800 0
   
State, Local, and Tribal Governments
 
   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 800 0 283 0 0 517
Annual IC Time Burden (Hours) 65 0 -194 0 0 259
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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