ED Discharge Overdose data (annual reporting)

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⚠️ Notice: This information collection may be referencing outdated material.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
ED Discharge Overdose data (annual reporting) Form and Instruction
ED Discharge Overdose Data Form Att E - ED_discharge overdose_Hosp_2.8.22.xlsx Form and Instruction
ED Discharge Overdose Data Form Att E - ED_discharge overdose_Hosp_2.8.22.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	ED Discharge Overdose data (annual reporting)	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	ED Discharge Overdose Data Form	Att E - ED_discharge overdose_Hosp_2.8.22.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23	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	23	-3	26
Annual IC Time Burden (Hours)	69	-9	78
Annual IC Cost Burden (Dollars)	2,061	-72	2,133

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.