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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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:

table that charts list of 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 %

table that charts list of burden
	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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Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.