Prepare and Submit EHR for Inpatient and Ambulatory

National Hospital Care Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0212 can be found here:

Documents and Forms

Document Name Document Type
Att W - Quarterly Data Trans of EHR Data.doc Instruction
Att G - List of Var for EHR Extract of IP Disch.docx EHR Variables - Inpatient Discharges IC Document
Att H - List of Var for EHR Extract of ED Visits.docx EHR Variables - Emergency Dept IC Document
Att I - List of Var for EHR Extract of OPD Visits.docx EHR Variables - Outpatient Dept IC Document

Information Collection (IC) Details

IC Title:	Prepare and Submit EHR for Inpatient and Ambulatory	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Att W - Quarterly Data Trans of EHR Data.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
EHR Variables - Inpatient Discharges	Att G - List of Var for EHR Extract of IP Disch.docx	02/19/2015
EHR Variables - Emergency Dept	Att H - List of Var for EHR Extract of ED Visits.docx	02/19/2015
EHR Variables - Outpatient Dept	Att I - List of Var for EHR Extract of OPD Visits.docx	02/19/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.