Information Collection

Grantee-Level PDMP Outcomes Module

IC 241772 under ICR 202602-0930-002 · OMB 0930-0377.

Documents and Forms

Document Name Document Type
Form Grantee-Level PDMP Grantee-Level PDMP Outcomes Module Grantee-Level PDMP Outcomes Module Form and Instruction
Grantee-Level PDMP Grantee-Level PDMP Outcomes Module Attachment 2 SPF Rx Grantee-Level PDMP Outcomes Module_2025_final.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Grantee-Level PDMP Outcomes Module	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	Grantee-Level PDMP Outcomes Module	Grantee-Level PDMP Outcomes Module	Attachment 2 SPF Rx Grantee-Level PDMP Outcomes Module_2025_final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26	5	21
Annual IC Time Burden (Hours)	65	12	53
Annual IC Cost Burden (Dollars)	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.

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