ED Discharge Overdose data (quarterly 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⚠️ Notice: This information collection may be referencing outdated material.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 (quarterly 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 (quarterly 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: 28	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	112	8	104
Annual IC Time Burden (Hours)	336	24	312
Annual IC Cost Burden (Dollars)	10,036	1,506	8,530

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.