Information Collection

Design And Pilot Test Of A Survey Of Visits To Hospital Outpatient And Emergency Departments

IC 110927 under ICR 198904-0920-003 · OMB 0920-0233.

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Information Collection (IC) Details

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IC Title:	DESIGN AND PILOT TEST OF A SURVEY OF VISITS TO HOSPITAL OUTPATIENT AND EMERGENCY DEPARTMENTS	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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	40	39	1
Annual IC Time Burden (Hours)	699	698	1
Annual IC Cost Burden (Dollars)	0	0	0

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