OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction

OMB 0930-0234 · HHS/SAMHSA.

OMB 0930-0234

The Drug Addiction Treatment Act of 2000 establishes conditions for physicians to obtain waivers to permit them to prescribe certain approved narcotic treatment medications for the maintenance or detoxification treatment of opioid addiction. Under the SUPPORT Act, this data collection will include other practitioners who meet the statutory requirements: nurse practitioners, physician assistants, nurse specialist, nurse-midwives, and registered nurse anesthetists. SAMHSA will adding three additional forms from OMB No. 0930-0369.

The latest form for Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction expires 2023-01-31 and is listed under ICR 201911-0930-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form NOI Qualifying Oth Qualifying Other PractitionerForm and Instruction
Form All Practitioner R Practitioner Reporting FormForm and Instruction
Form NOI 275 All Practi Notice to Treat up to 275 PatientsForm and Instruction
Form NOI Physicians 30 Notice to Treat up to 100 PatientsForm and Instruction
Supporting Statement for NOIs_OMB No. 0930-0234 _ 11-7-2022.docx (document unavailable)Supporting Statement A
NOI Qualifying Other Practitioner NP and PA 30 and 100_30E_Revised OIRA Questions and Edits_CLEAN.docx (document unavailable) Supplementary Document
0930-0234 NOI _ No Material or Nonsubstantive Change_5-26-2021_CLEAN.docx Supplementary Document
0930-0234 NOI _ No Material or Nonsubstantive Change_5-26-2021_CLEAN.docx Justification for No Material/Nonsubstantive Change
Attachment A Final NOI Physicians 30 and 100 Waiver- 01.24.2020.docx Supplementary Document
Attachment D - Notice of Intent.pdf Supplementary Document
Attachment A - DATA 2000.pdf Supplementary Document
Notification of Intent Instruction
Qualifying Other Practitioner Form and Instruction
Request for a Temporary Patient Increase Patient Increase for an Emergency - 8.655 Instruction
Practitioner Reporting Form Form and Instruction
Renewal Request for a Patient Limit Increase - 8.64 Instruction
Request for Patient Limit - 8.620 Instruction
Notice to Treat up to 275 Patients Form and Instruction
Notice to Treat up to 100 Patients Form and Instruction
Notification to Prescribe Immediately Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202211-0930-002 Extension without change of a currently approved collection 2022-11-08 Approved without change
202105-0930-001 No material or nonsubstantive change to a currently approved collection 2021-05-27 Approved without change
201911-0930-001 Revision of a currently approved collection 2019-12-04 Approved with change
201609-0930-001 Revision of a currently approved collection 2016-09-27 Approved with change
201607-0930-001 Revision of a currently approved collection 2016-07-13 Approved with change
201506-0930-001 Extension without change of a currently approved collection 2015-06-18 Approved without change
201204-0930-001 Extension without change of a currently approved collection 2012-04-13 Approved with change
200903-0930-001 Revision of a currently approved collection 2009-03-10 Approved without change
200512-0930-001 Revision of a currently approved collection 2005-12-16 Approved without change
200210-0930-002 Extension without change of a currently approved collection 2002-10-04 Approved with change
200209-0930-002 No material or nonsubstantive change to a currently approved collection 2002-09-30 Approved without change
200204-0930-001 New collection (Request for a new OMB Control Number) 2002-04-12 Approved with change

OMB Details

Notification of Intent

Federal Enterprise Architecture: Health - Public Health Monitoring