Information Collection

SOAR Data Form - Part II

IC 226017 under ICR 202301-0930-001 · OMB 0930-0329.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Part II SOAR Data Form - Part II	Form and Instruction
Part II Part II Attachment B- Part II- SOAR Data Form - Revisions 06-01-2022.docx	Form and Instruction
Part II Part II 0930 - 0329 Attachment B- Part II - SOAR Data Form _ samhsa.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Part II	Part II	0930 - 0329 Attachment B- Part II - SOAR Data Form _ samhsa.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

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	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	38	38
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.