Hospital Induction Interview 2019-2020

National Hospital Ambulatory Medical Care Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0278 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0278 Hospital Induction Interview 2019-2020 Form and Instruction
0920-0278 2019-2020 Hospital Induction Interview Attachment B - 2019 NHAMCS Hospital Induction form 083118.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Hospital Induction Interview 2019-2020	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
Form and Instruction	0920-0278	2019-2020 Hospital Induction Interview	Attachment B - 2019 NHAMCS Hospital Induction form 083118.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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

Number of Respondents: 227	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	227	227
Annual IC Time Burden (Hours)	114	114
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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