Qualifying Other Practitioner

Notification of Intent to Use Schedule III, IV, or V Opioid Drugs for the Maintenance and Detoxification Treatment of Opiate Addiction

Documents and Forms

Document Name Document Type
Form NOI Qualifying Oth Qualifying Other Practitioner Form and Instruction
NOI Qualifying Oth NOI Qualifying Other Practitioner NP and PA 30 and 100 Attachment B-NOI Qualifying Other Practitioner NP and PA 30 and 100_30E__Final_Clean.docx Form and Instruction
NOI Qualifying Oth NOI Qualifying Other Practitioner NP and PA 30 and 100 Attachment B-NOI Qualifying Other Practitioner NP and PA 30 and 100_30E__Final_Clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Qualifying Other Practitioner	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	NOI Qualifying Other Practitioner NP and PA 30 and	NOI Qualifying Other Practitioner NP and PA 30 and 100	Attachment B-NOI Qualifying Other Practitioner NP and PA 30 and 100_30E__Final_Clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,811	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,811	635	3,176
Annual IC Time Burden (Hours)	252	42	210
Annual IC Cost Burden (Dollars)	0	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.