ED Discharge Overdose data (quarterly reporting)

[NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)

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: Removed

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 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-112	112
Annual IC Time Burden (Hours)	-336	336
Annual IC Cost Burden (Dollars)	-10,036	10,036

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.