Information Collection

NHDS - Medical abstract form

IC 6666 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⚠️ Notice: This information collection may be referencing outdated material.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 1 HDS abstract form.pdf	Other-Medical Abstract Form
Attachment G1 cover.doc Cover sheet for Medical Abstract Form	IC Document

IC Title:

NHDS - Medical abstract form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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-Medical Abstract Form			Attachment G 1 HDS abstract form.pdf		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: 13

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	Previously Approved
Annual Number of Responses for this IC	3,250	-44,275	47,525
Annual IC Time Burden (Hours)	271	-2,137	2,408
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Cover sheet for Medical Abstract Form	Attachment G1 cover.doc	07/24/2008

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