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

Harm Reduction Toolkit for Non-Prescription Syringe Sales in Community Pharmacies

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Harm Reduction Toolkit for Non-Prescription Syringe Sales in Community Pharmacies (Pre-Test)	Agency IC Tracking Number:	02021DZ

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	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 %

	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

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.