Information Collection

Community-Level PDMP Outcomes Module

IC 241773 under ICR 202302-0930-002 · OMB 0930-0377.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0377 can be found here:

Documents and Forms

Document Name Document Type
Form Community-Level PD Community-Level PDMP Outcomes Module Form and Instruction
Form Community-Level PD Community-Level PDMP Outcomes Module Form and Instruction
Community-Level PD Community-Level PDMP Outcomes Module Attachment 3 SPF-Rx Community-Level PDMP Outcomes Module CLEAN - 13July2022.docx Form and Instruction
Community-Level PD Community-Level PDMP Outcomes Module Attachment 3 SPF-Rx Community-Level PDMP Outcomes Module CLEAN - 13July2022.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Community-Level PDMP Outcomes Module	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	Community-Level PDMP Outcomes Module	Community-Level PDMP Outcomes Module	Attachment 3 SPF-Rx Community-Level PDMP Outcomes Module CLEAN - 13July2022.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	110	110
Annual IC Time Burden (Hours)	138	138
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.