Private or Not-for-Profit Institutions

Distribution of Traceable Opioid Material* Kits (TOM Kits*) across U.S. Laboratories

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1313 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-20JE Private or Not-for-Profit Institutions Form and Instruction
0920-20JE TOM Kits Quesitons Att6 TOM Kits Questions (Word).docx Form and Instruction
Att6 TOM Kits Questions (Online Examples).pdf Online Example IC Document

Information Collection (IC) Details

IC Title:	Private or Not-for-Profit Institutions	Agency IC Tracking Number:	0920-20JE

Is this a Common Form? No		IC Status: New

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	0920-20JE	TOM Kits Quesitons	Att6 TOM Kits Questions (Word).docx		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 400

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Online Example	Att6 TOM Kits Questions (Online Examples).pdf	05/21/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.