Information Collection

Opioid Recovery Coach Model Bundled Evaluation Instrument

IC 248606 under ICR 202107-3045-003 · OMB 3045-0194.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Opioid Recovery Coach Model Bundled Evaluation Instrument	Form and Instruction
1 Opioid Recovery Coach Model Bundled Evaluation Instrumen 20200716 life cycle evaluation ORC Instruments.docx www.americorps.gov	Form and Instruction
1 Opioid Recovery Coach Model Bundled Evaluation Instrumen 20200716 life cycle evaluation ORC Instruments.docx www.americorps.gov	Form and Instruction

IC Title:

Agency IC Tracking Number:

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 and Instruction	1	Opioid Recovery Coach Model Bundled Evaluation Instrument	20200716 life cycle evaluation ORC Instruments.docx	www.americorps.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 422

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	422	422
Annual IC Time Burden (Hours)	218	218
Annual IC Cost Burden (Dollars)	19,982	19,982

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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