OD2A-LOCAL Annual Performance Report and Work Plan

[NCIPC] Monitoring and Reporting for the Overdose Data to Action Cooperative Agreement

Documents and Forms

Document Name Document Type
OD2A-LOCAL Annual Performance Report and Work Plan Form and Instruction
OD2A-LOCAL Annual Performance Report and Work Plan Attachment 3g_OD2A-LOCAL Annual Performance Report and Work Plan.docx Form and Instruction
OD2A-LOCAL Annual Performance Report and Work Plan Attachment 3g_OD2A-LOCAL Annual Performance Report and Work Plan.docx Form and Instruction

Information Collection (IC) Details

IC Title:	OD2A-LOCAL Annual Performance Report and Work Plan	Agency IC Tracking Number:	0920-1283

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	n/a	OD2A-LOCAL Annual Performance Report and Work Plan	Attachment 3g_OD2A-LOCAL Annual Performance Report and Work Plan.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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	Previously Approved
Annual Number of Responses for this IC	40	-26	66
Annual IC Time Burden (Hours)	360	294	66
Annual IC Cost Burden (Dollars)	0	-2,200	2,200

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.