Information Collection

NHDS - 2010 & 2011 Sample listing sheet

IC 186293 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⚠️ Notice: This information collection may be referencing outdated material.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 O National Survey Sampling listing sheet redesign.doc	Other-2010 & 2011 Sample listing she
Attachment P National Survey PATIENT ABSTRACT 6-27-08.doc Attachment P - Patient Discharge Abstraction Form	IC Document
Attachment P cover.doc Cover for patient abstraction form	IC Document

IC Title:

NHDS - 2010 & 2011 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-2010 & 2011 Sample listing sheet			Attachment O National Survey 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: 160

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	19,200	19,200
Annual IC Time Burden (Hours)	4,480	4,480
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment P - Patient Discharge Abstraction Form	Attachment P National Survey PATIENT ABSTRACT 6-27-08.doc	07/24/2008
Cover for patient abstraction form	Attachment P cover.doc	07/24/2008

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