Information Collection Request

[NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)

ICR 202504-0920-022 · OMB 0920-1268 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-1268 Inpatient Hospitalization Discharge Overdose Data Form Form and Instruction New Available
Form 0920-1268 Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly Form and Instruction New Missing upstream
Form 0920-1268 Inpatient Hospitalization Discharge Overdose Data Form Form and Instruction New Available
Form 0920-1268 Inpatient hospitalization discharge overdose data form - Health Department Total Inpatient Hospitalization Visits and Metadata - Yearly Form and Instruction New Available
Form 0920-1268 ED and Hospitalization Discharge Overdose Data Form Form and Instruction New Available
Form 0920-1268 ED and hospitalization discharge overdose data form - Health Department ED and inpatient hospital metadata - yearly Form and Instruction New Repair queued
Form 0920-1268 Rapid ED Overdose Death Form Form and Instruction New Available
Form 0920-1268 Rapid ED Overdose Data Form - Health Departments sharing data from Local Syndromic Data File Form and Instruction New Repair queued
Form 0920-1268 Rapid ED Overdose Death Form Form and Instruction New Available
Form 0920-1268 Rapid ED overdose Data Form - Health Departments sharing from NSSP BioSense Form and Instruction New Missing upstream
Form 0920-1268 ED Annual Discharge Overdose Data Form Form and Instruction Removed Available
Form 0920-1268 ED Discharge Overdose data (annual reporting) Form and Instruction Removed Repair queued
Rapid ED Data Submission Template Form and Instruction Removed Available
Rapid ED Overdose Data - Case-level Data Shared through NSSP Biosense Form and Instruction Removed Repair queued
Rapid ED Data Submission Template Form and Instruction Removed Available
Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File Form and Instruction Removed Repair queued
Federal Register CSTE Response - DOSE (2) (2).pdf Public Comments Uploaded 2025-07-11 Repair queued
PC_202504-0920-022_071125_045446_1.pdf Public Comments Uploaded 2025-07-11 Available
Federal Register CSTE Response - DOSE (2) (1).pdf Public Comments Uploaded 2025-07-11 Repair queued
PC_202504-0920-022_071125_043958_1.pdf Public Comments Uploaded 2025-07-11 Available
0920-1268 Att G_MMWR pubs.docx Supplementary Document Uploaded 2025-04-25 Available
0920-1268 Att G_MMWR pubs.docx Supplementary Document Uploaded 2025-04-25 Repair queued
0920-1268 Att F PIA.pdf Supplementary Document Uploaded 2025-04-25 Available
0920-1268 Att F PIA.pdf Supplementary Document Uploaded 2025-04-25 Missing upstream
0920-1268 Att C-RD.docx Supplementary Document Uploaded 2025-04-25 Available
0920-1268 Att C-RD.docx Supplementary Document Uploaded 2025-04-25 Available
0920-1268 Att B - 60day FRN.pdf Supplementary Document Uploaded 2025-04-25 Available
0920-1268 Att B - 60day FRN.pdf Supplementary Document Uploaded 2025-04-25 Repair queued
Crosswalk of Changes OMB_DOP_ADS (1).xlsx Supplementary Document Uploaded 2023-03-09 Repair queued
Crosswalk of Changes OMB_DOP_ADS (1).xlsx Supplementary Document Uploaded 2023-03-09 Repair queued
DOSE Request Non substantial change_DOPADSedits_030823.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-03-09 Repair queued
DOSE Request Non substantial change_DOPADSedits_030823.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-03-09 Missing upstream
Att F_Privacy Act Applicability.pdf Supplementary Document Uploaded 2022-02-17 Available
Att F_Privacy Act Applicability.pdf Supplementary Document Uploaded 2022-02-17 Missing upstream
Att D2_ Changes Crosswalk OMB.xlsx Supplementary Document Uploaded 2022-02-17 Repair queued
Att D2_ Changes Crosswalk OMB.xlsx Supplementary Document Uploaded 2022-02-17 Missing upstream
Att C_Research Determination.pdf Supplementary Document Uploaded 2022-02-17 Available
Att C_Research Determination.pdf Supplementary Document Uploaded 2022-02-17 Missing upstream
Att A2 - Authorizing Legislation Substance Use-Disorder Prevention.docx Supplementary Document Uploaded 2022-02-17 Available
Att A2 - Authorizing Legislation Substance Use-Disorder Prevention.docx Supplementary Document Uploaded 2022-02-17 Missing upstream
Att A1 - Authorizing Legislation PHSA.docx Supplementary Document Uploaded 2022-02-17 Available
Att A1 - Authorizing Legislation PHSA.docx Supplementary Document Uploaded 2022-02-17 Repair queued
0920-1268 SSB_04182025.docx Supporting Statement B Uploaded 2025-04-25 Repair queued
0920-1268 SSB_04182025.docx Supporting Statement B Uploaded 2025-04-25 Repair queued
0920-1268 SSA_04182025.docx Supporting Statement A Uploaded 2025-04-25 Available
0920-1268 SSA_04182025.docx Supporting Statement A Uploaded 2025-04-25 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
275054 Inpatient hospitalization discharge overdose data form - Health Department Line-level ED and Inpatient Hospitalization Discharge Data - Yearly Form and Instruction NewInpatient Hospitalization Discharge Overdose Data Form
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 NewInpatient Hospitalization Discharge Overdose Data Form
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 NewED and Hospitalization Discharge Overdose Data Form
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 NewRapid ED Overdose Death Form
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 NewRapid ED Overdose Death Form
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 RemovedED Annual Discharge Overdose Data Form
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 RemovedRapid ED Data Submission Template
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 RemovedRapid ED Data Submission Template
236480 Rapid ED Overdose Data from Local Syndromic or Hospital Discharge File Form and Instruction Removed
ICR Details
0920-1268 202504-0920-022
Active 202303-0920-004
HHS/CDC 0920-1268
[NCIPC] Drug Overdose Surveillance and Epidemiology (DOSE)
Revision of a currently approved collection   No
Regular
Approved without change 09/09/2025
Retrieve Notice of Action (NOA) 06/26/2025
  Inventory as of this Action Requested Previously Approved
09/30/2028 36 Months From Approved 09/30/2025
646 0 575
655 0 658
0 0 20,162

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.

US Code: 42 USC 241 Name of Law: PHSA
   US Code: 42 USC 280 Name of Law: Subtitle Q of the Substance Use-Disorder Prevention Act
  
None

Not associated with rulemaking

  89 FR 88774 11/08/2024
90 FR 24625 06/11/2025
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 646 575 0 71 0 0
Annual Time Burden (Hours) 655 658 0 -3 0 0
Annual Cost Burden (Dollars) 0 20,162 0 -20,162 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Revision for 0920-1268 aims to revise the number of eligible states, change the data collection template and revise burden. resulting in a decreased burden estimate of 655 hours.

$2,046,636
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Jeffrey Zirger 404 639-7118 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/26/2025