Rural Communities Opioid Response Program – Behavioral Health Care Support

Rural Communities Opioid Response Program (RCORP) Grantee Data

Documents and Forms

Document Name Document Type
Form 4 Rural Communities Opioid Response Program – Behavioral Health Care Support Form and Instruction
4 Rural Communities Opioid Response Program – Behavioral H BHS Measures to Share APPROVED (2023 Unchanged).pdf Form and Instruction
4 Rural Communities Opioid Response Program – Behavioral H BHS Measures to Share APPROVED (2023 Unchanged).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Rural Communities Opioid Response Program – Behavioral Health Care Support	Agency IC Tracking Number:

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	4	Rural Communities Opioid Response Program – Behavioral Health Care Support	BHS Measures to Share APPROVED (2023 Unchanged).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 58	Number of Respondents for Small Entity: 58

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	58	58
Annual IC Time Burden (Hours)	117	117
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.