Information Collection

Undetermined Risk Factors for Fentanyl-Related Overdose Deaths - Ohio

IC 218644 under ICR 201411-0920-013 · OMB 0920-1054.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.