View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Drug Overdose Prevention Information Needs Among African Americans, People Living in Rural Areas, and Young People Ages 12-17 Years Old 0920-1154-22GW
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1154 Parent Consent Form Attachment 3_Parent Consent Form_6.6.2022.docx Yes No Fillable Fileable
Form and Instruction 0920-1154 Screener Parents of Young People Attachment 4_Screener_Parents of Young People_7.5.2022.docx Yes No Fillable Fileable
Form and Instruction 0920-1154 Information Sheet for Young People Attachment 5_Information Sheet_Young People_6.13.2022.docx Yes No Fillable Fileable
Form and Instruction 0920-1154 Moderators Guide for Young People Attachment 6_Mod Guide_Young People_6.23.2022.docx Yes Yes Fillable Fileable
Form and Instruction 0920-1154 Screener African Americans Attachment 7_Screener_AA_7.5.2022.docx Yes No Fillable Fileable
Form and Instruction 0920-1154 Moderators Guide for African Americans Attachment 8_Mod Guide_AA_6.23.2022.docx Yes Yes Fillable Fileable
Form and Instruction 0920-1154 Screener Rural Participants Attachment 9_Screener_Rural PWUD_7.5.2022.docx Yes No Fillable Fileable
Form and Instruction 0920-1154 Moderators Guide for Rural Participants Attachment 10_Mod Guide_Rural PWUD_6.23.2022.docx Yes Yes Fillable Fileable

Health Health Care Services

 

300 0
   
Individuals or Households
 
   50 %

  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 300 0 300 0 0 0
Annual IC Time Burden (Hours) 109 0 109 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SSA SSA Drug Overdose Prevention_5.23.2022_final.docx 06/30/2022
SSB SSB Drug Overdose Prevention_5.3.2022.docx 06/30/2022
Authorizing Legislation Attachment 1_Public Health Service Act_42 USC 241.pdf 06/30/2022
IRB determination Attachment 2_IRB Approval Letter_6.23.2022.pdf 06/30/2022
Protocol Attachment 11_Support Protocol for Research Participants_5.3.2022.docx 06/30/2022
Privacy Act Determination Attachment 12_ Applicability of Privacy Act.pdf 06/30/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.