OMB control number

[NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)

OMB 0920-1268 · HHS/CDC.

OMB 0920-1268

The purpose of the Drug Overdose Surveillance and Epidemiology (DOSE) system (OMB Control No. 0920-1268) is to rapidly identify outbreaks and provide situational awareness of changes in emergency department (ED) visits involving suspected drug overdoses at the local, state, and regional level. This goal will be accomplished by standardizing and enhancing sharing of existing ED data locally collected by health departments with CDC. Data will be used to improve local, state, and regional situational awareness of all drug, all opioid, heroin, fentanyl, all stimulant, cocaine, methamphetamine, and benzodiazepine, overdose trends and response to acute local and multi-state drug outbreaks. This Revision aims to revise the number of eligible states, change the data collection template (see Attachment D-2), and revise burden. Based on current data sharing from states we have decreased our burden estimate to 655 from 975 hours.

The latest form for [NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE) expires 2028-09-30 and is listed under ICR 202504-0920-022.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 0920-1268 Inpatient Hospitalization Discharge Overdose Data Form	Form and Instruction
Form 0920-1268 Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly	Form and Instruction
Form 0920-1268 Inpatient Hospitalization Discharge Overdose Data Form	Form and Instruction
Form 0920-1268 Inpatient hospitalization discharge overdose data form - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly	Form and Instruction
Form 0920-1268 ED and Hospitalization Discharge Overdose Data Form	Form and Instruction
Form 0920-1268 ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly	Form and Instruction
Form 0920-1268 Rapid ED Overdose Death Form	Form and Instruction
Form 0920-1268 Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File	Form and Instruction
Form 0920-1268 Rapid ED Overdose Death Form	Form and Instruction
Form 0920-1268 Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense	Form and Instruction
Form 0920-1268 ED Annual Discharge Overdose Data Form	Form and Instruction
Form 0920-1268 ED Discharge Overdose data (annual reporting)	Form and Instruction
Rapid ED Data Submission Template	Form and Instruction
Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense	Form and Instruction
Rapid ED Data Submission Template	Form and Instruction
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction
Federal Register CSTE Response - DOSE (2) (2).pdf	Public Comments
PC_202504-0920-022_071125_045446_1.pdf	Public Comments
Federal Register CSTE Response - DOSE (2) (1).pdf (document unavailable)	Public Comments
PC_202504-0920-022_071125_043958_1.pdf	Public Comments
0920-1268 Att G_MMWR pubs.docx	Supplementary Document
0920-1268 Att G_MMWR pubs.docx	Supplementary Document
0920-1268 Att F PIA.pdf	Supplementary Document
0920-1268 Att F PIA.pdf	Supplementary Document
0920-1268 Att C-RD.docx	Supplementary Document
0920-1268 Att C-RD.docx	Supplementary Document
0920-1268 Att B - 60day FRN.pdf	Supplementary Document
0920-1268 Att B - 60day FRN.pdf	Supplementary Document
Crosswalk of Changes OMB_DOP_ADS (1).xlsx	Supplementary Document
Crosswalk of Changes OMB_DOP_ADS (1).xlsx	Supplementary Document
DOSE Request Non substantial change_DOPADSedits_030823.docx	Justification for No Material/Nonsubstantive Change
Att F_Privacy Act Applicability.pdf	Supplementary Document
Att F_Privacy Act Applicability.pdf	Supplementary Document
Att D2_ Changes Crosswalk OMB.xlsx	Supplementary Document
Att D2_ Changes Crosswalk OMB.xlsx	Supplementary Document
Att C_Research Determination.pdf	Supplementary Document
Att C_Research Determination.pdf	Supplementary Document
Att A2 - Authorizing Legislation Substance Use-Disorder Prevention.docx	Supplementary Document
Att A2 - Authorizing Legislation Substance Use-Disorder Prevention.docx	Supplementary Document
Att A1 - Authorizing Legislation PHSA.docx	Supplementary Document
Att A1 - Authorizing Legislation PHSA.docx	Supplementary Document
0920-1268 SSB_04182025.docx	Supporting Statement B
0920-1268 SSA_04182025.docx	Supporting Statement A
0920-1268 SSA_04182025.docx	Supporting Statement A
Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly	Form and Instruction
Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly	Form and Instruction
Inpatient hospitalization discharge overdose data form - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly	Form and Instruction
Inpatient hospitalization discharge overdose data form - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly	Form and Instruction
ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly	Form and Instruction
ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly	Form and Instruction
Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File	Form and Instruction
Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File	Form and Instruction
Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense	Form and Instruction
Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense	Form and Instruction
ED Discharge Overdose data (annual reporting)	Form and Instruction
ED Discharge Overdose data (annual reporting)	Form and Instruction
Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense	Form and Instruction
Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense	Form and Instruction
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202504-0920-022	Revision of a currently approved collection	2025-06-26
202303-0920-004	No material or nonsubstantive change to a currently approved collection	2023-03-09	Approved without change
202202-0920-002	Revision of a currently approved collection	2022-02-22	Approved without change
201906-0920-001	New collection (Request for a new OMB Control Number)	2019-07-05	Approved with change

OMB Details

Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
Form	Name	Electronic access	Type
Form None	Rapid ED Data Submission Template	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.