Information Collection

ED Discharge Overdose data (annual reporting)

IC 236483 under ICR 202303-0920-004 · OMB 0920-1268.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1268 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1268 ED Discharge Overdose data (annual reporting)	Form and Instruction
0920-1268 ED Annual Discharge Overdose Data Form Att E_template DD OD2A-S (1).xlsx	Form and Instruction
0920-1268 ED Annual Discharge Overdose Data Form Att E_template DD OD2A-S (1).xlsx	Form and Instruction

IC Title:

ED Discharge Overdose data (annual reporting)

Agency IC Tracking Number:

0920-1268-23DH

Is this a Common Form? No

IC Status: Modified

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	0920-1268	ED Annual Discharge Overdose Data Form	Att E_template DD OD2A-S (1).xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35	12	23
Annual IC Time Burden (Hours)	88	19	69
Annual IC Cost Burden (Dollars)	3,136	1,075	2,061

Documents for IC

table that charts IC Documents
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.