Request for Opioid Project Information from Patient Safety Organizations (PSOs)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Request for Opioid Project Information from Patient Safety Organizations (PSOs) Form and Instruction
1 Request for Opioid Project Information FINAL Request for Opioid Project Info 9.10.18 (002).docx Form and Instruction
Fast Track AHRQ PSO Opioid Summit.docx Supporting Statement IC Document
Cover Page.doc Cover Letter IC Document

Information Collection (IC) Details

IC Title:	Request for Opioid Project Information from Patient Safety Organizations (PSOs)	Agency IC Tracking Number:

IC Status: Unchanged

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	1	Request for Opioid Project Information	FINAL Request for Opioid Project Info 9.10.18 (002).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	Fast Track AHRQ PSO Opioid Summit.docx	09/11/2018
Cover Letter	Cover Page.doc	09/11/2018

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