OMB control number

Evaluation of the SAMHSA Naloxone Education and Distribution Program

OMB 0920-1222 · HHS/CDC.

OMB 0920-1222

To evaluate the Substance Abuse and Mental Health Services Administration (SAMHSA) Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths. This evaluation will seek to describe and understand the scope and impact of the program on overdose.

The latest form for Evaluation of the SAMHSA Naloxone Education and Distribution Program expires 2021-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Key Informant Selection Tool Form
Recruitment Contact Script Form and Instruction
ATT_H_SAMHSA&CDC_Naloxone_MOU_Signed.pdf Supplementary Document
Att_C - IRB Doc.pdf Supplementary Document
Att_B_60 Day FRN - 17AMP_Naloxone.pdf Supplementary Document
Att_A_ Authorizing Legislation.docx Supplementary Document
SSB_17AMP_Naloxone Eval_101017.docx Supporting Statement B
SSA_17AMP_030718.docx Supporting Statement A
Key Informant Selection Tool Form
Recruitment Contact Script Form and Instruction
Interview Guide for Laypersons Other-Interview guide
Interview Guide for Partners Other-Interview guide
Interview Guide for Grantees Other-Interview Guide
Focus Group Discussion Guide Other-Discussion guide

All Historical Document Collections

201711-0920-017

Approved with change

New collection (Request for a new OMB Control Number)

2017-12-19

OMB Details

Focus Group Discussion Guide

Federal Enterprise Architecture: Health - Consumer Health and Safety