Information Collection

OCA Locking Medication Bottle Evaluation Survey

IC 257468 under ICR 202201-0917-001 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0036-124 OCA Locking Medication Bottle Evaluation Survey OCA Locking Medication Bottle Evaluation Survey	Form and Instruction
0917-0036-124 OCA Locking Medication Bottle Evaluation Survey OCA Locking Medication Bottle Evaluation Survey Questions.docx	Form and Instruction
Generic Clearance Submission Template - Locking Medication Template.docx OCA Locking Med Bottle submission	IC Document

IC Title:

OCA Locking Medication Bottle Evaluation Survey

Agency IC Tracking Number:

124

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	0917-0036-124				No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	500	500
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OCA Locking Med Bottle submission		12/20/2022

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

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