OMB
.report
Search
Psychiatric Hospital Survey Report
PSYCHIATRIC HOSPITAL SURVEY REPORT
OMB: 0938-0104
IC ID: 166167
OMB.report
HHS/CMS
OMB 0938-0104
ICR 198107-0938-016
IC 166167
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0104 can be found here:
1983-01-17 - Reinstatement without change of a previously approved collection
1982-04-02 - Reinstatement with change of a previously 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:
PSYCHIATRIC HOSPITAL SURVEY REPORT
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
HCFA-1537A
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
370
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
370
0
0
0
0
370
Annual IC Time Burden (Hours)
4,562
0
0
0
0
4,562
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.