Information Collection

[PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns

IC 268184 under ICR 202410-0920-015 · OMB 0920-0879.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0879 [PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns	Form and Instruction
Form 0920-0879 [PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns	Form and Instruction
0920-0879 O2DA Partner Evaluation Survey: Screener and Annotated Q Attachment 2 - Programmed Survey_05.21.2024.docx	Form and Instruction
0920-0879 O2DA Partner Evaluation Survey: Screener and Annotated Q Attachment 2 - Programmed Survey_05.21.2024.docx	Form and Instruction
0920-0879 O2DA Partner Evaluation Survey: Screener and Annotated Q Attachment 1 - Survey Instrument_05.21.2024.docx	Form and Instruction
0920-0879 O2DA Partner Evaluation Survey: Screener and Annotated Q Attachment 1 - Survey Instrument_05.21.2024.docx	Form and Instruction
PHIC STLT Generic_SSA_05.28.2024.docx SSA	IC Document
PHIC STLT Generic_SSA_05.28.2024.docx SSA	IC Document
PHIC STLT Generic_SSB_05.28.2024.docx SSB	IC Document
PHIC STLT Generic_SSB_05.28.2024.docx SSB	IC Document
Attachment 3 - Recruitment Email.docx Initial Reach-Out Email Template and Survey Invitation	IC Document
Attachment 3 - Recruitment Email.docx Initial Reach-Out Email Template and Survey Invitation	IC Document
Attachment 4 - Reminder Email.docx REMINDER Email (Survey Request for OD2A Grantees)	IC Document
Attachment 4 - Reminder Email.docx REMINDER Email (Survey Request for OD2A Grantees)	IC Document
Attachment 5 - Final Reminder Email.docx Final Reminder Email (Closing soon: Survey for OD2A Grantees)	IC Document
Attachment 5 - Final Reminder Email.docx Final Reminder Email (Closing soon: Survey for OD2A Grantees)	IC Document
Attachment 6 - Respondent Universe_updated.docx Respondent Universe	IC Document
Attachment 6 - Respondent Universe_updated.docx Respondent Universe	IC Document
Attachment 7 - Project Determination_OD2A.pdf Project Determinatino (24GD)	IC Document
Attachment 7 - Project Determination_OD2A.pdf Project Determinatino (24GD)	IC Document
Attachment 8 - OD2A Campaign Assessment-PTA_20240524.pdf PIA (20240524)	IC Document
Attachment 8 - OD2A Campaign Assessment-PTA_20240524.pdf PIA (20240524)	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns

Agency IC Tracking Number:

0920-0879-24GD

IC Status: Unchanged

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	0920-0879	O2DA Partner Evaluation Survey: Screener and Annotated Questionnaire	Attachment 2 - Programmed Survey_05.21.2024.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879	O2DA Partner Evaluation Survey: Screener and Annotated Questionnaire	Attachment 1 - Survey Instrument_05.21.2024.docx		Yes	Yes	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

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
	Requested	Previously Approved
Annual Number of Responses for this IC	90	90
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
SSA	PHIC STLT Generic_SSA_05.28.2024.docx	06/04/2024
SSB	PHIC STLT Generic_SSB_05.28.2024.docx	06/04/2024
Initial Reach-Out Email Template and Survey Invitation	Attachment 3 - Recruitment Email.docx	06/04/2024
REMINDER Email (Survey Request for OD2A Grantees)	Attachment 4 - Reminder Email.docx	06/04/2024
Final Reminder Email (Closing soon: Survey for OD2A Grantees)	Attachment 5 - Final Reminder Email.docx	06/04/2024
Respondent Universe	Attachment 6 - Respondent Universe_updated.docx	06/04/2024
Project Determinatino (24GD)	Attachment 7 - Project Determination_OD2A.pdf	06/04/2024
PIA (20240524)	Attachment 8 - OD2A Campaign Assessment-PTA_20240524.pdf	06/04/2024

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