Qualifying Other Practitioner

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0234 can be found here:

Documents and Forms

Document Name Document Type
Form Qualifying Other P Qualifying Other Practitioner Form and Instruction
Qualifying Other P Qualifying Other Pratitioner Attachment B NOI Qualifying Other Practitioner NP and PA 30 and 100 9.16.2019.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Qualifying Other Practitioner	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	Qualifying Other Pratitioner	Qualifying Other Pratitioner	Attachment B NOI Qualifying Other Practitioner NP and PA 30 and 100 9.16.2019.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,176	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	3,176	1,826	1,350
Annual IC Time Burden (Hours)	210	-3,840	4,050
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.