HCPCS Alcohol and Drug Screening and Brief Intervention Survey

States adoption of Healthcare Common Procedure Coding System codes (H0049) and (H0050) and assessment of support provided by the Centers for Medicare & Medicaid Services

Documents and Forms

Document Name Document Type
Form 1 HCPCS Alcohol and Drug Screening and Brief Intervention Survey Form and Instruction
1 HCPCS Alcohol and Drug Screening and Brief Intervention HCPCS Survey - Final - ROCIS submission -- June 2008.doc Form and Instruction

Information Collection (IC) Details

IC Title:	HCPCS Alcohol and Drug Screening and Brief Intervention Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	1	HCPCS Alcohol and Drug Screening and Brief Intervention Survey	HCPCS Survey - Final - ROCIS submission -- June 2008.doc		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	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 Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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