Information Collection

Substance Use Identification in Human Services Programs and Referrals

IC 245564 under ICR 202010-0990-001 · OMB 0990-0421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Document Name Document Type
04_ASPE Generic - Attachment A_ Discussion Guide_and_Script_for_Verbal_Consent_FINAL.docx Other-Discussion Guide
02_ASPE Generic - SupportingStatement A__SUD Identification and Referrals in Human Services Programs_FINAL.docx Supporting Statement A IC Document
03_ASPE Generic - SupportingStatement B__SUD Identification and Referrals in Human Services Programs_FINAL.docx Supporting Statement B IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Substance Use Identification in Human Services Programs and Referrals	Agency IC Tracking Number:

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
Other-Discussion Guide			04_ASPE Generic - Attachment A_ Discussion Guide_and_Script_for_Verbal_Consent_FINAL.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

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

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	02_ASPE Generic - SupportingStatement A__SUD Identification and Referrals in Human Services Programs_FINAL.docx	02/03/2021
Supporting Statement B	03_ASPE Generic - SupportingStatement B__SUD Identification and Referrals in Human Services Programs_FINAL.docx	02/03/2021

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