Information Collection

Harm Reduction Toolkit for Non-Prescription Syringe Sales in Community Pharmacies (Pre-Test)

IC 249319 under ICR 202107-0920-011 · OMB 0920-1364.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-21DZ Harm Reduction Toolkit for Non-Prescription Syringe Sales in Community Pharmacies (Pre-Test)	Form
0920-21DZ Harm Reduction Toolkit for Non-Prescription Syringe Sale Attachment 6_Pre-test survey.docx	Form
Attachment 7a_ Screenshots for Pre- and Post-test surveys.docx Pharmacy Staff NPSS Pre/Post Survey	IC Document

IC Title:

Agency IC Tracking Number:

02021DZ

Is this a Common Form? No

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
Form	0920-21DZ	Harm Reduction Toolkit for Non-Prescription Syringe Sales in Community Pharmacies (Pre-Test Survey)	Attachment 6_Pre-test survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Pharmacy Staff NPSS Pre/Post Survey	Attachment 7a_ Screenshots for Pre- and Post-test surveys.docx	09/14/2021

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