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Rural Health Opioid Program
Rural Health Opioid Program Grant Performance Measures
OMB: 0906-0037
IC ID: 231350
OMB.report
HHS/HRSA
OMB 0906-0037
ICR 201810-0906-004
IC 231350
( )
Documents and Forms
Document Name
Document Type
Form 1
Rural Health Opioid Program
Form
1 RHOP draft PIMS.docx
RHOP draft PIMS.docx
Form
0906-0037 RHOP OMB Number and Expiration.jpg
0906-0037 RHOP OMB Number and Expiration
IC Document
0906-0037 RHOP Burden Statement.jpg
0906-0037 RHOP Burden Statement
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Rural Health Opioid Program
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
1
RHOP draft PIMS.docx
RHOP draft PIMS.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
10
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions
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
10
0
0
0
0
10
Annual IC Time Burden (Hours)
110
0
0
0
0
110
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0906-0037 RHOP OMB Number and Expiration
0906-0037 RHOP OMB Number and Expiration.jpg
10/24/2018
0906-0037 RHOP Burden Statement
0906-0037 RHOP Burden Statement.jpg
10/24/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.