Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Activity Progress Report and Work Plan Tool – Annual Reporting New 66 264 8802 Form and Instruction n/a Activity Progress Report and Work Plan Tool
Activity Progress Report and Work Plan Tool – Initial Population New 22 440 14670 Form and Instruction n/a Activity Progress Report and Work Plan Tool
Evaluation and Performance Measuring Plan Template - Annual Reporting New 66 264 8802 Form and Instruction n/a Evaluation and Performance Measuring Plan Template
Evaluation and Performance Measuring Plan Template – Initial Population New 22 264 8800 Form and Instruction n/a Evaluation and Performance Measuring Plan Template
Organizational Capacity Assessment - Annual Reporting New 66 66 2200 Form and Instruction n/a Overdose Prevention Capacity Assessment Tool
Organizational Capacity Assessment - Initial Population New 22 22 733 Form and Instruction n/a Overdose Prevention Capacity Assessment Tool
Surveillance Data Dissemination Plan New 22 22 733 Form and Instruction n/a Surveillance Data Dissemination Plan
Total burden requested under this ICR: 286 1342 44740  
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