Information Collection

Harm Reduction Data Collection Form

IC 254585 under ICR 202207-0930-002 · OMB 0930-0391.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Harm Reduction Dat Harm Reduction Data Collection Form	Form and Instruction
Form Harm Reduction Dat Harm Reduction Data Collection Form 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

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:

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	Harm Reduction Data Collection Form				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 %

table that charts list of burden
	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

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.

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