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State, Local, and Tribal Government Laboratories
[NCEH] Distribution of Traceable Opioid Material* Kits (TOM Kits*) across U.S. Laboratories
OMB: 0920-1313
IC ID: 241927
OMB.report
HHS/CDC
OMB 0920-1313
ICR 202401-0920-013
IC 241927
( )
Documents and Forms
Document Name
Document Type
Form 0920-1313
State, Local, and Tribal Government Laboratories
Form and Instruction
Form 0920-1313
State, Local, and Tribal Government Laboratories
Form and Instruction
0920-1313 Att5a Test Kit Applctn Qs US Labs (Word) 20221202
Att5a Test Kit Applctn Qs US Labs (Word) 20240116_clean.docx
Form and Instruction
0920-1313 Att5a Test Kit Applctn Qs US Labs (Word) 20221202
Att5a Test Kit Applctn Qs US Labs (Word) 20240116_clean.docx
Form and Instruction
Cayman_FASKit_Form_Domestic_Basic_2023-11-21.png
Screenshot
IC Document
Cayman_FASKit_Form_Domestic_Basic_2023-11-21.png
Screenshot
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
State, Local, and Tribal Government Laboratories
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) 20240116_clean.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
200
0
0
0
0
200
Annual IC Time Burden (Hours)
20
0
0
0
0
20
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Screenshot
Cayman_FASKit_Form_Domestic_Basic_2023-11-21.png
01/29/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.