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Information Collection

Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File

IC 275045 under ICR 202504-0920-022 · OMB 0920-1268.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File
 
No New
 
Voluntary
 

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

Health Public Health Monitoring

 

3 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 36 0 36 0 0 0
Annual IC Time Burden (Hours) 108 0 108 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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