Information Collection

Bureau of Health Workforce Substance Use Disorder Evaluation

IC 241617 under ICR 202004-0906-002 · OMB 0906-0054.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form B2 Bureau of Health Workforce Substance Use Disorder Evaluation	Form and Instruction
B1 Attachment B1 - NHSC LRP Participant Survey_FINAL 04.08. Attachment B1 - NHSC LRP Participant Survey_FINAL 04.08.20.docx	Form and Instruction
B2 Attachment B2 - NHSC LRP Site Survey_FINAL 04.08.20.docx Attachment B2 - NHSC LRP Site Survey_FINAL 04.08.20.docx	Form and Instruction
B5 Attachment B5 - Grantee Site Survey_FINAL 04.08.20.docx Attachment B5 - Grantee Site Survey_FINAL 04.08.20.docx	Form and Instruction
B6 Attachment B6 - Grantee Organization Survey_FINAL 04.08. Attachment B6 - Grantee Organization Survey_FINAL 04.08.20.docx	Form and Instruction
B3 Attachment B3 - Grantee Trainee Survey -- NORC response BHW - Attachment B3 - Grantee Trainee Survey -- NORC response CLEAN.docx	Form and Instruction
B4 Attachment B4 - Grantee Alumni Survey -- NORC response.d BHW - Attachment B4 - Grantee Alumni Survey -- NORC response.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	B2	Attachment B2 - NHSC LRP Site Survey_FINAL 04.08.20.docx	Attachment B2 - NHSC LRP Site Survey_FINAL 04.08.20.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B1	Attachment B1 - NHSC LRP Participant Survey_FINAL 04.08.20.docx	Attachment B1 - NHSC LRP Participant Survey_FINAL 04.08.20.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B5	Attachment B5 - Grantee Site Survey_FINAL 04.08.20.docx	Attachment B5 - Grantee Site Survey_FINAL 04.08.20.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B6	Attachment B6 - Grantee Organization Survey_FINAL 04.08.20.docx	Attachment B6 - Grantee Organization Survey_FINAL 04.08.20.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B3	Attachment B3 - Grantee Trainee Survey -- NORC response CLEAN.docx	BHW - Attachment B3 - Grantee Trainee Survey -- NORC response CLEAN.docx	Yes	Yes	Fillable Fileable
Form and Instruction	B4	Attachment B4 - Grantee Alumni Survey -- NORC response.docx	BHW - Attachment B4 - Grantee Alumni Survey -- NORC response.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 41,300

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	41,300	41,300
Annual IC Time Burden (Hours)	13,289	13,289
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.