Annual OD2A TA Survey

Evaluation of the Overdose Data to Action Technical Assistance Hub

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1355 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-21BL Annual OD2A TA Survey Form and Instruction
0920-21BL Annual OD2A TA Survey Att 4. Annual OD2A TA Survey.docx Form and Instruction
0920-21BL Annual OD2A TA Survey Att 4. Annual OD2A TA Survey.docx Form and Instruction
Att 6. Annual OD2A TA Survey Screenshots.pdf Annual OD2A TA Survey Screenshots IC Document
Att 6. Annual OD2A TA Survey Screenshots.pdf Annual OD2A TA Survey Screenshots IC Document

Information Collection (IC) Details

IC Title:	Annual OD2A TA Survey	Agency IC Tracking Number:	0920-21BL

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	0920-21BL	Annual OD2A TA Survey	Att 4. Annual OD2A TA Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 440	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	440	440
Annual IC Time Burden (Hours)	95	95
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Annual OD2A TA Survey Screenshots	Att 6. Annual OD2A TA Survey Screenshots.pdf	06/10/2021

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