Information Collection

NHDS - Pretest Sample Listing Sheet

IC 186288 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⚠️ Notice: This information collection may be referencing outdated material.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 J Pretest Sampling listing sheet redesign.doc	Other-Pretest Sample Listing Sheet
Attachment L PATIENT ABSTRACT June 25 08.doc Attachment L - Pretest Patient Abstraction Form	IC Document
Attachment L cover with burden.doc Cover sheet for abstraction form	IC Document

IC Title:

NHDS - Pretest Sample Listing Sheet

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-Pretest Sample Listing Sheet			Attachment J Pretest Sampling listing sheet redesign.doc		No	No	Paper Only

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: 10

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	100	100
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment L - Pretest Patient Abstraction Form	Attachment L PATIENT ABSTRACT June 25 08.doc	07/24/2008
Cover sheet for abstraction form	Attachment L cover with burden.doc	07/24/2008

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