Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File

Drug Overdose Surveillance and Epidemiology (DOSE)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1268 can be found here:

Documents and Forms

Document Name Document Type
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File Form and Instruction
Rapid ED Data Submission Template Att D - Rapid_ED_Data Submission Template_2.9.22.xlsx Form and Instruction
Rapid ED Data Submission Template Att D - Rapid_ED_Data Submission Template_2.9.22.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	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	None	Rapid ED Data Submission Template	Att D - Rapid_ED_Data Submission Template_2.9.22.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	120	-108	228
Annual IC Time Burden (Hours)	360	-324	684
Annual IC Cost Burden (Dollars)	10,753	-7,948	18,701

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.