Information Collection

Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense

IC 275044 under ICR 202504-0920-022 · OMB 0920-1268.

Documents and Forms

Document Name Document Type
Form 0920-1268 Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense Form and Instruction
Form 0920-1268 Rapid ED Overdose Death Form Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense Form and Instruction
0920-1268 Rapid ED Overdose Death Form 0920-1268 Att D_Rapid ED ODDF.xlsx Form and Instruction
0920-1268 Rapid ED Overdose Death Form 0920-1268 Att D_Rapid ED ODDF.xlsx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	0920-1268	Rapid ED Overdose Death Form	0920-1268 Att D_Rapid ED ODDF.xlsx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	540	540
Annual IC Time Burden (Hours)	270	270
Annual IC Cost Burden (Dollars)	0	0

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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].