[NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)

ICR 202504-0920-022

OMB: 0920-1268

Federal Form Document

Forms and Documents

Document Name	Status
Form 0920-1268 Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly Form and Instruction	New
Form 0920-1268 Inpatient hospitalization discharge overdose data form - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly Form and Instruction	New
Form 0920-1268 ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly Form and Instruction	New
Form 0920-1268 Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File Form and Instruction	New
Form 0920-1268 Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense Form and Instruction	New
Form 0920-1268 ED Discharge Overdose data (annual reporting) Form and Instruction	Removed
Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense Form and Instruction	Removed
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File Form and Instruction	Removed
0920-1268 Att G_MMWR pubs.docx Supplementary Document	2025-04-25
0920-1268 Att F PIA.pdf Supplementary Document	2025-04-25
0920-1268 Att C-RD.docx Supplementary Document	2025-04-25
0920-1268 Att B - 60day FRN.pdf Supplementary Document	2025-04-25
Crosswalk of Changes OMB_DOP_ADS (1).xlsx Supplementary Document	2023-03-09
DOSE Request Non substantial change_DOPADSedits_030823.docx Justification for No Material/Nonsubstantive Change	2023-03-09
Att F_Privacy Act Applicability.pdf Supplementary Document	2022-02-17
Att D2_ Changes Crosswalk OMB.xlsx Supplementary Document	2022-02-17
Att C_Research Determination.pdf Supplementary Document	2022-02-17
Att A2 - Authorizing Legislation Substance Use-Disorder Prevention.docx Supplementary Document	2022-02-17
Att A1 - Authorizing Legislation PHSA.docx Supplementary Document	2022-02-17
0920-1268 SSB_04182025.docx Supporting Statement B	2025-04-25
0920-1268 SSA_04182025.docx Supporting Statement A	2025-04-25

IC Document Collections

IC ID	Document Title	Status
275054	Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly Form and Instruction	New
275053	Inpatient hospitalization discharge overdose data form - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly Form and Instruction	New
275052	ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly Form and Instruction	New
275045	Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File Form and Instruction	New
275044	Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense Form and Instruction	New
236483	ED Discharge Overdose data (annual reporting) Form and Instruction	Removed
236481	Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense Form and Instruction	Removed
236480	Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File Form and Instruction	Removed