Rapid ED Overdose data form - State HD

Drug Overdose Surveillance and Epidemiology (DOSE)

OMB: 0920-1268

IC ID: 236480

Information Collection (IC) Details

View Information Collection (IC)

Rapid ED Overdose data form - State HD
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Rapid ED Overdose Data Att D_Rapid_ED_Overdose_Data_Form_5_22_2019.xlsx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

19 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 228 0 228 0 0 0
Annual IC Time Burden (Hours) 684 0 684 0 0 0
Annual IC Cost Burden (Dollars) 18,701 0 18,701 0 0 0

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

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