[NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)

OMB 0920-1268

This new data collection effort is an essential component toward reducing the opioid crisis, one of HHS Department’s top priorities. DOSE data is critical to our ability to rapidly identify outbreaks and provide situational awareness of changes in emergency department (ED) visits involving suspected drug, opioid, heroin and stimulant overdoses at the local, state, and regional level. DOSE allows health departments to rapidly share existing ED data on counts of ED visits using standard data forms and CDC case definitions.

The latest form for [NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE) expires 2022-08-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
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 - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly 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 Data Form - Health Departments sharing data from Local Syndromic Data File Form and Instruction
Form 0920-1268 Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense Form and Instruction
Form 0920-1268 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 from Local Syndromic or Hospital Discharge File Form and Instruction
0920-1268 Att G_MMWR pubs.docx Supplementary Document
0920-1268 Att F PIA.pdf Supplementary Document
0920-1268 Att C-RD.docx Supplementary Document
0920-1268 Att B - 60day FRN.pdf 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 D2_ Changes Crosswalk OMB.xlsx Supplementary Document
Att C_Research Determination.pdf Supplementary Document
Att A2 - Authorizing Legislation Substance Use-Disorder Prevention.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
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
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 from NSSP BioSense 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 from Local Syndromic or Hospital Discharge File Form and Instruction

All Historical Document Collections

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

OMB Details

Rapid ED Overdose data form - State HD

Federal Enterprise Architecture: Health - Public Health Monitoring

Form none

Rapid ED Overdose Data

Fillable Fileable

Form

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