Undetermined Risk Factors for Fentanyl-Related Overdose Deaths - Ohio

Drug Overdose Response Investigation (DORI) Data Collections

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1054 can be found here:

Documents and Forms

Document Name Document Type
Undetermined Risk Factors for Fentanyl-Related Overdose Deaths - Ohio Form and Instruction
Interview Guide - Opioid Drug Users Att 2 Interview Guide_Opiod Drug Users.docx Form and Instruction
Interview Guide - Harm Reduction Practitioners Att 3 Interview Guide_Harm Reduction Pracitioners.docx Form and Instruction
Att 1 OH Request Letter.PDF Letter of Invitation - Ohio IC Document
Request Protocol Templ GenDORI - Fentanyl-heroin overdose deaths OH.docx DORI GenIC Request IC Document

Information Collection (IC) Details

IC Title:	Undetermined Risk Factors for Fentanyl-Related Overdose Deaths - Ohio	Agency IC Tracking Number:	0920-1054

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	NA	Interview Guide - Opioid Drug Users	Att 2 Interview Guide_Opiod Drug Users.docx	NA	No		Paper Only
Form and Instruction	NA	Interview Guide - Harm Reduction Practitioners	Att 3 Interview Guide_Harm Reduction Pracitioners.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: 09-20-0113 - Epidemic Investigation Case Records	FR Citation: 51 FR 42466

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation - Ohio	Att 1 OH Request Letter.PDF	10/20/2015
DORI GenIC Request	Request Protocol Templ GenDORI - Fentanyl-heroin overdose deaths OH.docx	10/20/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.