Information Collection

Opioid Recovery Coach Model Bundled Evaluation Instrument

IC 248606 under ICR 202107-3045-003 · OMB 3045-0194.

Documents and Forms

Document Name Document Type
Form 1 Opioid Recovery Coach Model Bundled Evaluation Instrument Form and Instruction
1 Opioid Recovery Coach Model Bundled Evaluation Instrumen 20200716 life cycle evaluation ORC Instruments.docx www.americorps.gov Form and Instruction
1 Opioid Recovery Coach Model Bundled Evaluation Instrumen 20200716 life cycle evaluation ORC Instruments.docx www.americorps.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Opioid Recovery Coach Model Bundled Evaluation Instrument	Agency IC Tracking Number:

Is this a Common Form? No		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	1	Opioid Recovery Coach Model Bundled Evaluation Instrument	20200716 life cycle evaluation ORC Instruments.docx	www.americorps.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 422	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	422	422
Annual IC Time Burden (Hours)	218	218
Annual IC Cost Burden (Dollars)	19,982	19,982

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.