Change Request_Crosswalk 07JAN2026

OMB 0920-1461 change request crosswalk.docx

[NCIPC] Overdose Response Strategy Data Collection

Change Request_Crosswalk 07JAN2026

OMB: 0920-1461

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*Required fields Removed fields New or changed fields

Form

Original field

Requested Change

Reason for Change

SSA - Pg. 1

Jessica Wolff

Stephanie Rubel

Staffing changes

SSA – Pg. 4

Goals and strategies

Strategies and activities

Needed to align with updated program strategy and activity categories.

SSA – Pg. 11

For example, users can select from a list of demographic and geographic areas in describing project areas of focus, and users can describe a partner using categories that include Community-Based Organization, Criminal/Juvenile Justice, Healthcare/Medical, Social and Supportive Services, and Other, each with several standard subcategories.

Removed

No longer applicable.

SSA – Pg. 13

key contacts, collaborators

Project team

Needed to align with updated instrument Att I – ORS Quarterly Reporting Template

SSA – Pg. 14

Presentations, documents, activities completed this quarter, targets for next quarter and success stories

Outcomes in progress and outcomes completed

Needed to align with updated instrument Att I – ORS Quarterly Reporting Template

Att I – ORS Quarterly Reporting Template Pg. 2

Is this a pilot project?* (binary)

Is this project in your current action plan?* (binary field)

Moved to new section, Quarterly Overview. Needed to note which projects are included in action plans and which are not.

Att I – ORS Quarterly Reporting Template Pg. 2

ORS Goals & Strategies*

ORS Strategies & Activities* (drop down selection)

Moved to new section, Quarterly Overview. Needed to align with updated program strategy and activity categories.

Att I – ORS Quarterly Reporting Template Pg. 2

[NEW ITEM]

Quarterly Overview

Needed to align with updated program strategy and activity categories.

Att I – ORS Quarterly Reporting Template Pg. 3

ORS Collaborators

ORS Project Team

Needed to more accurately document who is part of the ORS project team.

Att I – ORS Quarterly Reporting Template Pg. 3

ORS Staff Name

Removed

No longer needed for evaluation purposes.

Att I – ORS Quarterly Reporting Template Pg. 3

ORS Staff Role

ORS Collaborator* (drop down selection)

Needed to more accurately document who is part of the ORS project team.

Att I – ORS Quarterly Reporting Template Pg. 3 & 4

Key Contacts section

Removed

No longer needed for evaluation purposes.

Att I – ORS Quarterly Reporting Template Pg. 4

Organizations section

Removed

No longer needed for evaluation purposes.

Att I – ORS Quarterly Reporting Template Pg. 6

Documents section

Replaced with specific outcome measures for applicable activities. Section below “Outcomes Completed”

Separate section no longer needed for evaluation purposes. This change streamlines data entry by having users only report documents if the applicable strategy and activity are selected (see Appendix A for revised structure).

Att I – ORS Quarterly Reporting Template Pg. 6 & 7

Presentations section

Replaced with specific outcome measures for applicable activities. Section below “Outcomes Completed”

Separate section no longer needed for evaluation purposes. This change streamlines data entry by having users only report presentations if the applicable strategy and activity are selected (see Appendix A for revised structure).

Att I – ORS Quarterly Reporting Template Pg. 7

Activities Completed (free text field)

Outcomes in Progress* (fillable table)

Prompts reporting of a standard set of completed outcomes only for those strategy(ies) and activity(ies) selected by the reporter. (see Appendix A for the revised structure).

Att I – ORS Quarterly Reporting Template Pg. 7

Activities With Targets (free text field)

Outcomes in Progress* (free text field)

Reporters will no longer be setting quarterly targets. Standard outcomes are used instead. Reporters are only required to report outcomes in progress when applicable (see Appendix A for the revised structure).

Att I – ORS Quarterly Reporting Template Pg. 7

Activities Without Targets (free text field)

Removed

No longer applicable.

Att I – ORS Quarterly Reporting Template Pg. 7

Targets for Next Quarter (free text field)

Removed

No longer applicable.

Att I – ORS Quarterly Reporting Template Pg. 7

New section added

Outcomes Completed

This change streamlines data entry by having users only report presentations if the applicable strategy and activity are selected (see Appendix A for revised structure).

Att I – ORS Quarterly Reporting Template Appendix A.

Field: ORS Goals and Strategies

Field: ORS Strategies and Activities

Updated the entire section to align with program language

Att I – ORS Quarterly Reporting Template Appendix A.

Fields: Partner Categories, Audience Section

Fields: Partner Categories, Audience Section

Updated the entire section to align with program language









Appendix A























Project Updates

Quarterly Overview

ORS Strategies and Activities

✔At least one strategy and one corresponding activity is required.

Selection


See list in appendix

Select all strategies and activities that are applicable to the activities of the project for this quarter.

Is this project in your current action plan?

Binary


Yes

No

Indicates whether the project is currently listed in ORS team’s annual action plan.

ORS Project Team

Primary Data Reporter

Selection


Checkbox

This is assigned to the staff member who created the project. A national administrator can update the primary data reporter as needed.

ORS Collaborator

Selection


Filters by list of state/jurisdiction staff

First and last name of staff member who supported the project during the reporting quarter.

Project Focus

Geographies

State/Jurisdiction

Selection


All U.S. states/ territories with ORS teams

State/jurisdiction(s) impacted by the activities of the project. Only 1 state can be selected per row, so the counties are specific to that 1 state. However, users can add multiple rows if the project covers multiple states.

Counties


Selection


All counties within applicable state/jurisdiction

Within state/jurisdiction, specific counties impacted by the activities of the project.

Cities


Selection


Major cities within applicable state/jurisdiction

Within state/jurisdiction, specific cities impacted by the activities of the project.

Populations

Was this project designed to impact populations disproportionately at risk for overdose?


Character

1000


One to three sentences describing populations impacted by the project.

Substances

Did the project target a specific substance?


Selection


Select if yes

Selection is completed only if project activities were focused on addressing specific substances. Otherwise, users do not need to take any action.

Substance

if the field appears because the previous question was selected.

Selection


Opioids

Stimulants

Hallucinogens

Depressants

Cannabis

Polysubstances

Select one or more substance categories if specifically impacted by project activities. All options cannot be selected. All options cannot be selected; if the project addressed all substances rather than one or more specific categories then the previous question should not be selected.

Outcomes in Progress (only if outcome is not yet completed)

Outcomes in Progress

✔ if no data to enter into Outcomes Completed table below, otherwise N

Character

1,000


Description of outcomes in progress not captured in completed outcome table below.

Outcomes Completed

  • Reporter is only required to input one outcome in the table below. If no outcome is reported, then the “Outcomes in Progress” section above requires completion.

Strategy 1 (The following 6 outcomes only display if Strategy 1 is selected):

1. Enhanced existing data system

2. Created new data system

3. Delivered presentation(s)/briefing(s)

4. Created report (including, but not limited to, briefs, bulletins, visualizations, dashboards)

5. Delivered ODMAP presentation(s)

6. Executed ODMAP participation agreement(s)


For each Strategy 1 outcome, the following measures are collected:

Description

Character

1,000


Description of support provided by ORS team for the designated outcome.

Partner Supported

Selection


Checkbox, see appendix for list of valid values. If “Other” is selected, a description must be provided.

Type(s) of partner(s) supported for the outcome completed.

Total Number*


Numeric

3

1-999

Total number of reports or ODMAP participation agreements executed.

Estimated Number of Attendees


Numeric

3

1-999

Estimated number of people who attended presentation(s) or briefing(s).

*Only collected for Strategy 1, Outcomes 4, 6

Only collected for Strategy 1, Outcome 3

Strategy 2 (The following 10 outcomes only display if Strategy 2 is selected):

1. Established new multi-sector team (OFR)

2. Established new multi-sector team (PHAST)

3. Established new multi-sector team (Other)

4. Supported existing multi-sector team (OFR)

5. Supported existing multi-sector team (PHAST)

6. Supported existing multi-sector team (Other)

7. Enhanced jurisdictional partnerships/collaboration

8. Created/implemented OFR recommendation

9. Developed multi-sector rapid response/spike response plan

10. Tested and/or enhanced multi-sector rapid response/spike plan


For each Strategy 2 outcome, the following measures are collected:

Description

Character

1,000


Description of support provided by ORS team for the designated outcome.

Partner Supported

Selection


Checkbox, see appendix for list of valid values. If “Other” is selected, a description must be provided.

Type(s) of partner(s) supported for the outcome completed.

Strategy 3 (The following 7 outcomes only display if Strategy 3 is selected):

1. Developed educational/informational materials

2. Developed communication campaign(s)

3. Developed training

4. Delivered training

5. Hosted community event

6. Supported community event

7. Evaluated results of training or event


For each Strategy 3 outcome, the following measures are collected:

Description

Character

1,000


Description of support provided by ORS team for the designated outcome.

Audience Type

Selection


Checkbox, see appendix for list of valid values. If “Other” is selected, a description must be provided.

Type(s) of audience that received educational/informational materials, communication campaigns, trainings or intended audience of community events.

Total Number*

Numeric

3

1-999

Total number of educational or information materials, communication campaigns or trainings delivered,

Estimated Number of Attendees


Numeric

3

1-999

Estimated number of people who attended trainings or who provided feedback on trainings.

*Only collected for Strategy 3, Outcomes 1, 2, 4

Only collected for Strategy 3, Outcomes 4, 7

Strategy 4 (The following 4 outcomes only display if Strategy 4 is selected):

1. Developed protocol

2. Provided Technical Assistance session

3. Implemented new program/intervention

4. Supported existing program/intervention


For each Strategy 4 outcome, the following measures are collected:

Description

Character

1,000


Description of support provided by ORS team for the designated outcome.

Partner Supported

Selection


Checkbox, see appendix for list of valid values. If “Other” is selected, a description must be provided.

Type(s) of partner(s) supported for the outcome completed.

Other Completed Activities

Are there other completed outcomes you would like to report?


Selection


Checkbox

Since activities only display when a strategy is selected, this field provides teams an opportunity to view the full list of reportable outcomes. When this checkbox is selected, teams will be able to report on outcomes that did not populate automatically.


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AuthorMina Rasheed
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