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Ambulatory Unit Induction Interview 2022
National Hospital Ambulatory Medical Care Survey
OMB: 0920-0278
IC ID: 241281
OMB.report
HHS/CDC
OMB 0920-0278
ICR 202201-0920-017
IC 241281
( )
Documents and Forms
Document Name
Document Type
Form 0920-22BT
Ambulatory Unit Induction Interview 2022
Form and Instruction
0920-22BT Attachment E - Ambulatory Unit Induction Questionnaire (
Attachment E - Ambulatory Unit Induction Questionnaire (2022).docx
Form and Instruction
0920-22BT Attachment E - Ambulatory Unit Induction Questionnaire (
Attachment E - Ambulatory Unit Induction Questionnaire (2022).docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Ambulatory Unit Induction Interview 2022
Agency IC Tracking Number:
0920-22BT
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
0920-22BT
Attachment E - Ambulatory Unit Induction Questionnaire (2022)
Attachment E - Ambulatory Unit Induction Questionnaire (2022).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
FR Citation:
49 FR 37693
Number of Respondents:
820
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
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
820
0
0
0
0
820
Annual IC Time Burden (Hours)
205
0
0
0
0
205
Annual IC Cost Burden (Dollars)
12,070
0
0
0
0
12,070
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.