ADDITION OF UNIFORM HOSPITAL DISCHARGE DATA SET ITEMS TO HOSPITAL DISCHARGE SURVEY

ICR 197801-0937-002

OMB: 0937-0004

Federal Form Document

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ICR Details
0937-0004 197801-0937-002
Historical Active 197801-0937-001
HHS/OASH
ADDITION OF UNIFORM HOSPITAL DISCHARGE DATA SET ITEMS TO HOSPITAL DISCHARGE SURVEY
Extension without change of a currently approved collection   No
Regular
Approved without change 01/09/1978
Retrieve Notice of Action (NOA) 01/09/1978
  Inventory as of this Action Requested Previously Approved
12/31/1978 12/31/1978 11/30/1978
220,000 0 235,000
14,667 0 15,667
0 0 0



None
None


No

1
IC Title Form No. Form Name
ADDITION OF UNIFORM HOSPITAL DISCHARGE DATA SET ITEMS TO HOSPITAL DISCHARGE SURVEY HSM88-1

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 220,000 235,000 0 0 -15,000 0
Annual Time Burden (Hours) 14,667 15,667 0 0 -1,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/09/1978


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