OMB
.report
Search
Annual Hospital Interview
National Hospital Care Survey
OMB: 0920-0212
IC ID: 186283
OMB.report
HHS/CDC
OMB 0920-0212
ICR 202110-0920-008
IC 186283
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0212 can be found here:
2024-07-26 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-0212
Annual Hospital Interview
Form and Instruction
0920-0212 Att C - Annual Hospital Interview
Att C - Annual Hospital Interview v2.docx
Form and Instruction
0920-0212 Att C - Annual Hospital Interview
Att C - Annual Hospital Interview v2.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Annual Hospital Interview
Agency IC Tracking Number:
0920-0212
Is this a Common Form?
No
IC Status:
Modified
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
0920-0212
Att C - Annual Hospital Interview
Att C - Annual Hospital Interview v2.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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:
608
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
608
0
10
0
0
598
Annual IC Time Burden (Hours)
1,216
0
20
0
0
1,196
Annual IC Cost Burden (Dollars)
0
0
0
0
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.