Information Collection

Program-Level Instrument

IC 234465 under ICR 202606-0930-003 · OMB 0930-0384.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SOR TOR FInal Tool SOR TOR Final Tool Program-Level Instrument	Form and Instruction
SOR TOR FInal Tool SOR TOR Final Tool 20250203 SOR TOR Program Instrument Rev for Harm Reduction RL1_Updated 6.10.26.docx	Form and Instruction
0930-0384_GRPA SOR TOR Non-substantive Change Justification-OMB Passback 2-11June2026.docx Non-Sub Change Justification Statement	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	SOR TOR FInal Tool				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Program-Level Instrument

FR Citation: 75 FR 28264

Number of Respondents: 378

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	945	945
Annual IC Time Burden (Hours)	274	274
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Non-Sub Change Justification Statement		06/23/2026

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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