Information Collection

Rural Communities Opioid Response Program-Implementation

IC 237084 under ICR 202602-0906-002 · OMB 0906-0044.

Documents and Forms

Document Name Document Type
Form 1a Implementation Measures Rural Communities Opioid Response Program-Implementation Form and Instruction
Form 1b MAT Expansion Measures Rural Communities Opioid Response Program-Implementation Form and Instruction
1a Implementation Measures Implementation Measures to Share APPROVED.pdf Form and Instruction
1b MAT Expansion Measures MAT Expansion Measures to Share APPROVED.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rural Communities Opioid Response Program-Implementation	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	1a	Implementation Measures	Implementation Measures to Share APPROVED.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	1b	MAT Expansion Measures	MAT Expansion Measures to Share APPROVED.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 290	Number of Respondents for Small Entity: 290

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	580	580
Annual IC Time Burden (Hours)	719	719
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.

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