OMB
.report
Search
Medical Responsibility Statement For Use Of Methadone In A Treatment Program
MEDICAL RESPONSIBILITY STATEMENT FOR USE OF METHADONE IN A TREATMENT PROGRAM
OMB: 0910-0042
IC ID: 109451
OMB.report
HHS/FDA
OMB 0910-0042
ICR 197810-0910-003
IC 109451
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0910-0042 can be found here:
1980-11-28 - Reinstatement with change of a previously approved collection
1980-01-10 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MEDICAL RESPONSIBILITY STATEMENT FOR USE OF METHADONE IN A TREATMENT PROGRAM
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
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
FD-2633
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
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
200
0
0
0
0
200
Annual IC Time Burden (Hours)
100
0
0
0
0
100
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.