Private or Not-for-Profit Institutions

[NCEH] Distribution of Traceable Opioid Material* Kits (TOM Kits*) across U.S. Laboratories

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1313 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1313 Private or Not-for-Profit Institutions Form and Instruction
Form 0920-1313 Private or Not-for-Profit Institutions Form and Instruction
0920-1313 Att5a Test Kit Applctn Qs US Labs (Word) 20221202 Att5a Test Kit Applctn Qs US Labs (Word) 20221202.docx Form and Instruction
0920-1313 Att5a Test Kit Applctn Qs US Labs (Word) 20221202 Att5a Test Kit Applctn Qs US Labs (Word) 20221202.docx Form and Instruction
0920-1313 Test Kit Application and Questions for U.S. Laboratories Att5a Test Kit Applctn Qs US Labs (screenshots) 20230410.png Form and Instruction
0920-1313 Test Kit Application and Questions for U.S. Laboratories Att5a Test Kit Applctn Qs US Labs (screenshots) 20230410.png Form and Instruction
Att5a Test Kit Applctn Qs US Labs (screenshots) 20221202.jpg Screenshot IC Document
Att5a Test Kit Applctn Qs US Labs (screenshots) 20221202.jpg Screenshot IC Document

Information Collection (IC) Details

IC Title:	Private or Not-for-Profit Institutions	Agency IC Tracking Number:	0920-1313

Is this a Common Form? Yes		IC Status: Modified

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	0920-1313	Att5a Test Kit Applctn Qs US Labs (Word) 20221202	Att5a Test Kit Applctn Qs US Labs (Word) 20221202.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1313	Test Kit Application and Questions for U.S. Laboratories (online)	Att5a Test Kit Applctn Qs US Labs (screenshots) 20230410.png	NA	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Emergency Response

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 200

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Screenshot	Att5a Test Kit Applctn Qs US Labs (screenshots) 20221202.jpg	12/13/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.