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 can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form NOI Qualifying Oth Qualifying Other Practitioner Form and Instruction
Form All Practitioner R Practitioner Reporting Form Form and Instruction
Form NOI 275 All Practi Notice to Treat up to 275 Patients Form and Instruction
Form NOI Physicians 30 Notice to Treat up to 100 Patients Form 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 (document unavailable) 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 (document unavailable) 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

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

OMB Details

Notification of Intent

Federal Enterprise Architecture: Health - Public Health Monitoring