View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Translating Evidence to Practice Implementation Tools for Preventing Overdose	Agency IC Tracking Number:	0920-1050-25-0037

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
Form and Instruction	0920-1050	Recruitment Letter	Recruitment email_Att 2.docx	N/A	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1050	Tools for Overdose Prevention Survey	Tools for Overdose Survey_Att 1.pdf	N/A	Yes	Yes	Fillable Fileable

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: 540	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 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	540	0	540	0	0	0
Annual IC Time Burden (Hours)	189	0	189	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
0920-1050 GenIC Request Template	0080 NCMW 1050 Request Template Service Delivery_UPDATED - 3-3-25.docx	03/07/2025

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