Information Collection

Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File

IC 236480 under ICR 202504-0920-022 · OMB 0920-1268.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction
Rapid ED Data Submission Template Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction
Rapid ED Data Submission Template Att D - Rapid_ED_Data Submission Template_2.9.22.xlsx	Form and Instruction
Rapid ED Data Submission Template Att D - Rapid_ED_Data Submission Template_2.9.22.xlsx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	None				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-120	120
Annual IC Time Burden (Hours)	-360	360
Annual IC Cost Burden (Dollars)	-10,753	10,753

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.

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