Information Collection

Request for Opioid Project Information from Patient Safety Organizations (PSOs)

IC 232977 under ICR 202501-0935-001 · OMB 0935-0179.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Request for Opioid Project Information from Patient Safety Organizations (PSOs)	Form and Instruction
Form 1 Request for Opioid Project Information Request for Opioid Project Information from Patient Safety Organizations (PSOs)	Form and Instruction
1 Request for Opioid Project Information FINAL Request for Opioid Project Info 9.10.18 (002).docx	Form and Instruction
1 Request for Opioid Project Information FINAL Request for Opioid Project Info 9.10.18 (002).docx	Form and Instruction
Fast Track AHRQ PSO Opioid Summit.docx Supporting Statement	IC Document
Fast Track AHRQ PSO Opioid Summit.docx Supporting Statement	IC Document
Cover Page.doc Cover Letter	IC Document
Cover Page.doc Cover Letter	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: Removed

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-40	40
Annual IC Time Burden (Hours)	-7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement		09/11/2018
Cover Letter		09/11/2018

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

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