Information Collection Request

Bureau of Health Workforce (BHW) Substance Use Disorder (SUD) Evaluation

ICR 202004-0906-002 · OMB 0906-0054 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form B4 Attachment B4 - Grantee Alumni Survey -- NORC response.docx Form and Instruction New Available
Form B3 Attachment B3 - Grantee Trainee Survey -- NORC response CLEAN.docx Form and Instruction New Available
Form B6 Attachment B6 - Grantee Organization Survey_FINAL 04.08.20.docx Form and Instruction New Available
Form B5 Attachment B5 - Grantee Site Survey_FINAL 04.08.20.docx Form and Instruction New Available
Form B2 Attachment B2 - NHSC LRP Site Survey_FINAL 04.08.20.docx Form and Instruction New Available
Form B1 Attachment B1 - NHSC LRP Participant Survey_FINAL 04.08.20.docx Form and Instruction New Available
Attachment A - 60 day FRN.pdf Supplementary Document Uploaded 2020-05-01 Available
Attachment C14 - Grantee Follow-up Phone Script_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C13 - SMS Reminder_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C12 - Reminder Letter - All Surveys_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C11 - Reminder Email to Grantees about Contact Information_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C10 - Survey Advertisement Text_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C9 - Reminder Email from HRSA to NHSC Participants and Sites_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C8 - Reminder Email from HRSA to Grantees_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C7 - Reminder Email from Grantees_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C6 - Reminder Email - All Surveys_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C5 - Introductory Email Template_All Surveys_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C4 - Contact Information Request Template_FINAL 04.08.20.xlsx Supplementary Document Uploaded 2020-04-29 Available
Attachment C3 - Introductory Email from Grantees_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C2 - Contact Information Request Email_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
Attachment C1 - Advance Introduction to Grantees_FINAL 04.08.20.docx Supplementary Document Uploaded 2020-04-29 Available
BHW SUD Supporting Statement B -- NORC response CLEAN.docx Supporting Statement B Uploaded 2020-06-30 Available
BHW SUD Supporting Statement A --NORC_response CLEAN.docx Supporting Statement A Uploaded 2020-06-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
241617 Bureau of Health Workforce Substance Use Disorder Evaluation Form and Instruction NewAttachment B4 - Grantee Alumni Survey -- NORC response.docx
241617 Bureau of Health Workforce Substance Use Disorder Evaluation Form and Instruction NewAttachment B3 - Grantee Trainee Survey -- NORC response CLEAN.docx
241617 Bureau of Health Workforce Substance Use Disorder Evaluation Form and Instruction NewAttachment B6 - Grantee Organization Survey_FINAL 04.08.20.docx
241617 Bureau of Health Workforce Substance Use Disorder Evaluation Form and Instruction NewAttachment B5 - Grantee Site Survey_FINAL 04.08.20.docx
241617 Bureau of Health Workforce Substance Use Disorder Evaluation Form and Instruction NewAttachment B2 - NHSC LRP Site Survey_FINAL 04.08.20.docx
241617 Bureau of Health Workforce Substance Use Disorder Evaluation Form and Instruction NewAttachment B1 - NHSC LRP Participant Survey_FINAL 04.08.20.docx

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2023 36 Months From Approved
41,300 0 0
13,289 0 0
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Bureau of Health Workforce Substance Use Disorder Evaluation B1, B2, B5, B6, B3, B4 ,   ,   ,   ,   ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 41,300 0 0 41,300 0 0
Annual Time Burden (Hours) 13,289 0 0 13,289 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No