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Hospital Induction Interview 2020
National Hospital Ambulatory Medical Care Survey
OMB: 0920-0278
IC ID: 214297
OMB.report
HHS/CDC
OMB 0920-0278
ICR 202201-0920-017
IC 214297
( )
Documents and Forms
Document Name
Document Type
Hospital Induction Interview 2020
Form and Instruction
Hospital induction questionnaire 2020
Attachment C1 - Induction questionnaire (2020) 04.09.2020.docx
Form and Instruction
Hospital induction questionnaire 2020
Attachment C1 - Induction questionnaire (2020) 04.09.2020.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Hospital Induction Interview 2020
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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
none
Hospital induction questionnaire 2020
Attachment C1 - Induction questionnaire (2020) 04.09.2020.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:
Health Resources Utilization Statistics (09-20-0167)
FR Citation:
49 FR 37693
Number of Respondents:
137
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
137
0
0
0
0
137
Annual IC Time Burden (Hours)
69
0
0
0
0
69
Annual IC Cost Burden (Dollars)
8,041
0
0
0
0
8,041
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.