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View Information Collection (IC)

View Information Collection (IC)

Emergency Department Alternatives to Opioids Program (ED-ALT)
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction ED-ALT Collection Template Yes Yes Fillable Fileable

Health Public Health Monitoring

Privacy Act of 1974 (Title 5 United States Code [U.S.C.] 552a)  75 FR 28264

15 0
   
State, Local, and Tribal Governments
 
   100 %

  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 30 0 30 0 0 0
Annual IC Time Burden (Hours) 1,800 0 1,800 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
ED-ALT Generic Request Template 06/12/2024
ED-ALT Report Instructions 05/29/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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