OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

[OADPS] OD2A-LOCAL Cooperative Agreement (# CD23-0003)

IC 270561 under ICR 202507-0920-013 · OMB 0920-1282.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1282 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Techincal Guidance [OADPS] OD2A-LOCAL Cooperative Agreement (# CD23-0003)	Form
Excel Reporting Tool [OADPS] OD2A-LOCAL Cooperative Agreement (# CD23-0003)	Form and Instruction
Techincal Guidance AttA_OD2A LOCAL PM Technical Guidance_MAY 2025.docx	Form
Excel Reporting Tool AttB_OD2A LOCAL Excel Reporting Tool_MAY 2025.xlsx	Form and Instruction
PEO GenIC Request_OD2A-LOCAL.pdf GenIC Request Memo	IC Document
AttC_OD2A_LOCAL_Contextual and Data Quality Questions for PMs_May 2025.pdf Data entry guide	IC Document
OD2A_LOCAL email notification.docx Email Notification	IC Document
PPEO GenIC Change Request for Overdose Data to Action_LOCAL 2025 May.docx Change Request Justification	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[OADPS] OD2A-LOCAL Cooperative Agreement (# CD23-0003)

Agency IC Tracking Number:

0920-25-0127

IC Status: Unchanged

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	n/a				Yes	Yes	Fillable Fileable
Form and Instruction	n/a				Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	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	80	0	0	0	0	80
Annual IC Time Burden (Hours)	1,400	0	0	0	0	1,400
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request Memo		08/30/2024
Data entry guide		07/03/2025
Email Notification		08/30/2024
Change Request Justification		07/03/2025

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].