View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Prescription Drug Overdose Prevention for States Program Assessment	Agency IC Tracking Number:	0920-0879-18FK

IC Status: New

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
Other-Interview Guide			Attachment C_Instrument- Telephone Interview Guide.docx		Yes	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 87	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	87	0	87	0	0	0
Annual IC Time Burden (Hours)	174	0	174	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	PFS-EVAL-SSA.DOCX	11/13/2017
Supporting Statement B	PFS-EVAL-SSB.docx	11/13/2017
List of Awardees	Attachment A_List of PfS Awardees.docx	11/13/2017
Strategies and Activities	Attachment B_PfS Strategies and Activities.docx	11/13/2017
Recruitment Email	Attachment D_Recruitment E-mail.docx	11/13/2017
Reminder Email	Attachment E_Reminder E-mail.docx	11/13/2017
Confirmation Email	Attachment F_Confirmation E-mail.docx	11/13/2017
Follow-up Email	Attachment G_Follow-up E-mail.docx	11/13/2017

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