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

[NCSTLTPHIW] Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

OMB: 0920-0879

IC ID: 268184

Documents and Forms
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Form and Instruction
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Information Collection (IC) Details

View Information Collection (IC)

[PHIC] Assessing Funded Overdose Data to Action (OD2A) Grantee Implementation and Impacts of Stop Overdose Campaigns 0920-0879-24GD
 
Unchanged
 
Voluntary
 

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

Health Illness Prevention

 

90 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 90 0 0 0 0 90
Annual IC Time Burden (Hours) 38 0 0 0 0 38
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
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