OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly

IC 275052 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

View Information Collection (IC)

ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly
 
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 ED and Hospitalization Discharge Overdose Data Form 0920-1268 Att E_ED discharge.xlsx N/A Yes Yes Fillable Fileable

Health Public Health Monitoring

 

32 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 32 0 32 0 0 0
Annual IC Time Burden (Hours) 96 0 96 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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