Information Collection

Line 7 National Survey Facility Questionnaire

IC 183893 under ICR 200802-0920-012 · OMB 0920-0780.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0780 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 7 Line 7 National Survey Facility Questionnaire	Form and Instruction
7 National Survey Facility Questionnaire Attachment O-National Facility Qx[1].12192007.doc	Form and Instruction

IC Title:

Line 7 National Survey Facility Questionnaire

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

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
Form and Instruction	7	National Survey Facility Questionnaire	Attachment O-National Facility Qx[1].12192007.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health Resources Utilization Statistics

FR Citation: 49 FR 37697

Number of Respondents: 750

Number of Respondents for Small Entity: 200

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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