Harm Reduction Data Collection Form

Harm Reduction Grant Program Target Setting and Quarterly Aggregate Reporting Instrument

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0391 can be found here:

Documents and Forms

Document Name Document Type
Form Harm Reduction Dat Harm Reduction Data Collection Form Form and Instruction
Harm Reduction Dat Harm Reduction Data Collection Form Attachment A HR OMB Data Collection Form REVISED 05202022-clean.docx Form and Instruction
Harm Reduction Dat Harm Reduction Data Collection Form Attachment A HR OMB Data Collection Form REVISED 05202022-clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Harm Reduction Data Collection Form	Agency IC Tracking Number:

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	Harm Reduction Data Collection Form	Harm Reduction Data Collection Form	Attachment A HR OMB Data Collection Form REVISED 05202022-clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Harm Reduction Data Collection Form	FR Citation: 75 FR 28264

Number of Respondents: 23	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	115	115
Annual IC Time Burden (Hours)	72	72
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.