Information Collection

Rural Communities Opioid Response Program – Behavioral Health Care Support

IC 260925 under ICR 202602-0906-002 · OMB 0906-0044.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 RCORP-BHS Measures Rural Communities Opioid Response Program – Behavioral Health Care Support	Form and Instruction
4 RCORP-BHS Measures RCORP-BHS Measures Clean 02182026.docx	Form and Instruction

IC Title:

Rural Communities Opioid Response Program â Behavioral Health Care Support

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	4				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 58

Number of Respondents for Small Entity: 58

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	58	58
Annual IC Time Burden (Hours)	117	117
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.

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