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Att E_ORS Annual Evaluation Survey- Public Health Partner
[NCIPC] Overdose Response Strategy Data Collection
OMB:
IC ID: 275742
OMB.report
CDC
ICR 202506-0920-007
IC 275742
( )
Documents and Forms
Document Name
Document Type
Form 0920-25AC
Att E_ORS Annual Evaluation Survey- Public Health Partner
Form
0920-25AC ORS Annual Evaluation Survey- PHP
Att F_ORS Annual Evaluation Survey- PHP.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att E_ORS Annual Evaluation Survey- Public Health Partner
Agency IC Tracking Number:
0920-25AC
Is this a Common Form?
No
IC Status:
New
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
0920-25AC
ORS Annual Evaluation Survey- PHP
Att F_ORS Annual Evaluation Survey- PHP.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
70
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
70
0
70
0
0
0
Annual IC Time Burden (Hours)
35
0
35
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
