Information Collection

NHDS - Hospital In-house Tape or Printout Transmittal Notice

IC 186284 under ICR 200808-0920-008 · OMB 0920-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment G 5 Automated data transmittal.doc	Other-Attachment G5 - Hospital In-ho
Attachment G 5 Cover.doc Cover sheet for in-house transmittal notice	IC Document

IC Title:

NHDS - Hospital In-house Tape or Printout Transmittal Notice

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
Other-Attachment G5 - Hospital In-house Tape or Printout Transmittal Notice			Attachment G 5 Automated data transmittal.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health Resource Utilization Statistics

FR Citation: 49 FR 37697

Number of Respondents: 29

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	348	348
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover sheet for in-house transmittal notice	Attachment G 5 Cover.doc	07/24/2008

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