[NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1268 ED Annual Discharge Overdose Data Form	Form and Instruction	Modified	Available
Form 0920-1268 ED Discharge Overdose data (annual reporting)	Form and Instruction	Modified	Repair queued
ED Discharge Overdose Data Form	Form and Instruction	Removed	Available
ED Discharge Overdose data (quarterly reporting)	Form and Instruction	Removed	Repair queued
Rapid ED Data Submission Template	Form and Instruction	Modified	Available
Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense	Form and Instruction	Modified	Repair queued
Rapid ED Data Submission Template	Form and Instruction	Unchanged	Repair queued
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction	Unchanged	Repair queued
Crosswalk of Changes OMB_DOP_ADS (1).xlsx	Supplementary Document	Uploaded 2023-03-09	Repair queued
DOSE Request Non substantial change_DOPADSedits_030823.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-03-09	Repair queued
Att F_Privacy Act Applicability.pdf	Supplementary Document	Uploaded 2022-02-17	Repair queued
Att D2_ Changes Crosswalk OMB.xlsx	Supplementary Document	Uploaded 2022-02-17	Repair queued
Att C_Research Determination.pdf	Supplementary Document	Uploaded 2022-02-17	Repair queued
Att B_ 60 Dy FRN DOSE 1268.pdf	Supplementary Document	Uploaded 2022-02-17	Repair queued
Att A2 - Authorizing Legislation Substance Use-Disorder Prevention.docx	Supplementary Document	Uploaded 2022-02-17	Repair queued
Att A1 - Authorizing Legislation PHSA.docx	Supplementary Document	Uploaded 2022-02-17	Repair queued
SSB_DOSE_02092022.docx	Supporting Statement B	Uploaded 2022-02-17	Repair queued
SSA_DOSE_2.9.22.docx	Supporting Statement A	Uploaded 2022-02-17	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
236483	ED Discharge Overdose data (annual reporting)	Form and Instruction	Modified	ED Annual Discharge Overdose Data Form
236483	ED Discharge Overdose data (annual reporting)	Form and Instruction	Modified
236482	ED Discharge Overdose data (quarterly reporting)	Form and Instruction	Removed	ED Discharge Overdose Data Form
236482	ED Discharge Overdose data (quarterly reporting)	Form and Instruction	Removed
236481	Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense	Form and Instruction	Modified	Rapid ED Data Submission Template
236481	Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense	Form and Instruction	Modified
236480	Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction	Unchanged	Rapid ED Data Submission Template
236480	Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1268	ICR Reference No: 202303-0920-004
Status: Historical Active	Previous ICR Reference No: 202202-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1268-23DH
Title: [NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/24/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/09/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2025	09/30/2025	09/30/2025
Responses	575	0	675
Time Burden (Hours)	658	0	975
Cost Burden (Dollars)	20,162	0	29,123

---

Abstract: This non-substantial change request is for the following changes: 1) Remove quarterly data collection for emergency department (ED)/hospitalization discharge overdose data, 2) Increase the number of states submitting ED/hospitalization discharge overdose data from 28 to 35, 3) Request line-level ED/hospitalization discharge overdose data instead of aggregate counts. These changes will not alter the purpose of DOSE, the methods, or interpretation of DOSE data.

---

Authorizing Statute(s): US Code: 42 USC 280 Name of Law: Subtitle Q of the Substance Use-Disorder Prevention Act
   US Code: 42 USC 241 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 22052	04/26/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 9622	02/22/2022
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
ED Discharge Overdose data (annual reporting)	0920-1268	ED Annual Discharge Overdose Data Form
ED Discharge Overdose data (quarterly reporting)	None	ED Discharge Overdose Data Form
Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense	None	Rapid ED Data Submission Template
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	None	Rapid ED Data Submission Template

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	575	675	0	12	-112	0
Annual Time Burden (Hours)	658	975	0	19	-336	0
Annual Cost Burden (Dollars)	20,162	29,123	0	1,075	-10,036	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This non-substantial change request will result in an overall reduction in the currently approved total annual burden and costs for respondents, from 975 hours ($29,123) to 657.5 hours ($19,640), due to the elimination of the aggregation process which takes time to complete and removing quarterly data submissions. Changes will also allow CDC the ability to have access to complete line-level data making the data more actionable and granular (e.g., drug combinations can now be analyzed).

---

Annual Cost to Federal Government: $1,164,111

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/09/2023

---