[NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1268 Inpatient Hospitalization Discharge Overdose Data Form	Form and Instruction	New	Available
Form 0920-1268 Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly	Form and Instruction	New	Repair queued
Form 0920-1268 Inpatient Hospitalization Discharge Overdose Data Form	Form and Instruction	New	Available
Form 0920-1268 Inpatient hospitalization discharge overdose data form - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly	Form and Instruction	New	Available
Form 0920-1268 ED and Hospitalization Discharge Overdose Data Form	Form and Instruction	New	Available
Form 0920-1268 ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly	Form and Instruction	New	Repair queued
Form 0920-1268 Rapid ED Overdose Death Form	Form and Instruction	New	Available
Form 0920-1268 Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File	Form and Instruction	New	Repair queued
Form 0920-1268 Rapid ED Overdose Death Form	Form and Instruction	New	Available
Form 0920-1268 Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense	Form and Instruction	New	Repair queued
Form 0920-1268 ED Annual Discharge Overdose Data Form	Form and Instruction	Removed	Available
Form 0920-1268 ED Discharge Overdose data (annual reporting)	Form and Instruction	Removed	Repair queued
Rapid ED Data Submission Template	Form and Instruction	Removed	Available
Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense	Form and Instruction	Removed	Repair queued
Rapid ED Data Submission Template	Form and Instruction	Removed	Available
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction	Removed	Repair queued
Federal Register CSTE Response - DOSE (2) (2).pdf	Public Comments	Uploaded 2025-07-11	Available
PC_202504-0920-022_071125_045446_1.pdf	Public Comments	Uploaded 2025-07-11	Available
Federal Register CSTE Response - DOSE (2) (1).pdf	Public Comments	Uploaded 2025-07-11	Repair queued
PC_202504-0920-022_071125_043958_1.pdf	Public Comments	Uploaded 2025-07-11	Available
0920-1268 Att G_MMWR pubs.docx	Supplementary Document	Uploaded 2025-04-25	Available
0920-1268 Att G_MMWR pubs.docx	Supplementary Document	Uploaded 2025-04-25	Repair queued
0920-1268 Att F PIA.pdf	Supplementary Document	Uploaded 2025-04-25	Available
0920-1268 Att F PIA.pdf	Supplementary Document	Uploaded 2025-04-25	Repair queued
0920-1268 Att C-RD.docx	Supplementary Document	Uploaded 2025-04-25	Available
0920-1268 Att C-RD.docx	Supplementary Document	Uploaded 2025-04-25	Available
0920-1268 Att B - 60day FRN.pdf	Supplementary Document	Uploaded 2025-04-25	Available
0920-1268 Att B - 60day FRN.pdf	Supplementary Document	Uploaded 2025-04-25	Repair queued
Crosswalk of Changes OMB_DOP_ADS (1).xlsx	Supplementary Document	Uploaded 2023-03-09	Available
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
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	Available
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	Available
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	Available
Att C_Research Determination.pdf	Supplementary Document	Uploaded 2022-02-17	Repair queued
Att A2 - Authorizing Legislation Substance Use-Disorder Prevention.docx	Supplementary Document	Uploaded 2022-02-17	Available
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	Available
Att A1 - Authorizing Legislation PHSA.docx	Supplementary Document	Uploaded 2022-02-17	Repair queued
0920-1268 SSB_04182025.docx	Supporting Statement B	Uploaded 2025-04-25	Repair queued
0920-1268 SSB_04182025.docx	Supporting Statement B	Uploaded 2025-04-25	Repair queued
0920-1268 SSA_04182025.docx	Supporting Statement A	Uploaded 2025-04-25	Available
0920-1268 SSA_04182025.docx	Supporting Statement A	Uploaded 2025-04-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
275054	Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly	Form and Instruction	New	Inpatient Hospitalization Discharge Overdose Data Form
275054	Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly	Form and Instruction	New
275053	Inpatient hospitalization discharge overdose data form - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly	Form and Instruction	New	Inpatient Hospitalization Discharge Overdose Data Form
275053	Inpatient hospitalization discharge overdose data form - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly	Form and Instruction	New
275052	ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly	Form and Instruction	New	ED and Hospitalization Discharge Overdose Data Form
275052	ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly	Form and Instruction	New
275045	Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File	Form and Instruction	New	Rapid ED Overdose Death Form
275045	Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File	Form and Instruction	New
275044	Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense	Form and Instruction	New	Rapid ED Overdose Death Form
275044	Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense	Form and Instruction	New
236483	ED Discharge Overdose data (annual reporting)	Form and Instruction	Removed	ED Annual Discharge Overdose Data Form
236483	ED Discharge Overdose data (annual reporting)	Form and Instruction	Removed
236481	Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense	Form and Instruction	Removed	Rapid ED Data Submission Template
236481	Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense	Form and Instruction	Removed
236480	Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction	Removed	Rapid ED Data Submission Template
236480	Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction	Removed

ICR Details

OMB Control No: 0920-1268	ICR Reference No: 202504-0920-022
Status: Active	Previous ICR Reference No: 202303-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1268
Title: [NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/09/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/26/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2028	36 Months From Approved	09/30/2025
Responses	646	0	575
Time Burden (Hours)	655	0	658
Cost Burden (Dollars)	0	0	20,162

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Abstract: The purpose of the Drug Overdose Surveillance and Epidemiology (DOSE) system (OMB Control No. 0920-1268) is to rapidly identify outbreaks and provide situational awareness of changes in emergency department (ED) visits involving suspected drug overdoses at the local, state, and regional level. This goal will be accomplished by standardizing and enhancing sharing of existing ED data locally collected by health departments with CDC. Data will be used to improve local, state, and regional situational awareness of all drug, all opioid, heroin, fentanyl, all stimulant, cocaine, methamphetamine, and benzodiazepine, overdose trends and response to acute local and multi-state drug outbreaks. This Revision aims to revise the number of eligible states, change the data collection template (see Attachment D-2), and revise burden. Based on current data sharing from states we have decreased our burden estimate to 655 from 975 hours.

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

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 88774	11/08/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 24625	06/11/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

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 and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly	0920-1268	ED and Hospitalization Discharge Overdose Data Form
Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly	0920-1268	Inpatient Hospitalization Discharge Overdose Data Form
Inpatient hospitalization discharge overdose data form - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly	0920-1268	Inpatient Hospitalization 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 Form - Health Departments sharing data from Local Syndromic Data File	0920-1268	Rapid ED Overdose Death Form
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	None	Rapid ED Data Submission Template
Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense	0920-1268	Rapid ED Overdose Death Form

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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	646	575	0	71	0	0
Annual Time Burden (Hours)	655	658	0	-3	0	0
Annual Cost Burden (Dollars)	0	20,162	0	-20,162	0	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Revision for 0920-1268 aims to revise the number of eligible states, change the data collection template and revise burden. resulting in a decreased burden estimate of 655 hours.

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Annual Cost to Federal Government: $2,046,636

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

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Common Form ICR:  No

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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: 06/26/2025

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