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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.