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Hospital Discharge Survey
HOSPITAL DISCHARGE SURVEY
OMB: 0937-0004
IC ID: 112176
OMB.report
HHS/OASH
OMB 0937-0004
ICR 197512-0937-002
IC 112176
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0937-0004 can be found here:
1987-08-06 - Revision of a currently approved collection
1986-05-23 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HOSPITAL DISCHARGE SURVEY
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
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
HSM88-1
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
235,000
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
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
235,000
0
0
0
0
235,000
Annual IC Time Burden (Hours)
11,750
0
0
0
0
11,750
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.