Information Collection

Rural Communities Opioid Response Program-Implementation

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

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	1a				Yes	Yes	Fillable Fileable
Form and Instruction	1b				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 %

table that charts list of burden
	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

table that charts IC Documents
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].