[NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)

ICR 202303-0920-004

OMB: 0920-1268

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-1268 can be found here:

2025-06-26 - Revision of a currently approved collection

Forms and Documents

Document Name	Status
Form 0920-1268 ED Discharge Overdose data (annual reporting) Form and Instruction	Modified
ED Discharge Overdose data (quarterly reporting) Form and Instruction	Removed
Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense Form and Instruction	Modified
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File Form and Instruction	Unchanged
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 B_ 60 Dy FRN DOSE 1268.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
SSB_DOSE_02092022.docx Supporting Statement B	2022-02-17
SSA_DOSE_2.9.22.docx Supporting Statement A	2022-02-17

IC Document Collections

IC ID	Document Title	Status
236483	ED Discharge Overdose data (annual reporting) Form and Instruction	Modified
236482	ED Discharge Overdose data (quarterly reporting) Form and Instruction	Removed
236481	Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense Form and Instruction	Modified
236480	Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File Form and Instruction	Unchanged

ICR Details

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