National Hospital Discharge Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NHDS OMB change SS to add 2010 082609.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2009-08-31	Available
Attachment P National Survey PATIENT ABSTRACT 6-27-08.doc	Supplementary Document	Uploaded 2008-07-24	Available
Attachment L PATIENT ABSTRACT June 25 08.doc	Supplementary Document	Uploaded 2008-07-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6666	NHDS - Medical abstract form	Other-Medical Abstract Form	Modified
186294	NHDS - 2010 & 2011 Verify Sampling and Reabstract	Other-2010 & 2011 Verify Sample and Reabstraction	Modified
186293	NHDS - 2010 & 2011 Sample listing sheet	Other-2010 & 2011 Sample listing sheet	Modified
186292	NHDS - 2010 & 2011 Facility Questionnaire	Other-Facility Questionnaire	Modified
186291	MHDS - 2010 & 2011 Survey Presentation to Hospitals	Other-2010 & 2011 Survey Presentation to Hospitals	Modified
186290	NHDS - Pretest Debrief Hospital Staff Guide	Other-Pretest Debrief Hospital Staff Guide	Modified
186289	NHDS - Pretest Verify Sampling and Reabstract	Other-Pretest Verify Sampling and Reabstract	Modified
186288	NHDS - Pretest Sample Listing Sheet	Other-Pretest Sample Listing Sheet	Modified
186287	NHDS - Pretest Facility Questionnaire	Other-Pretest Facililty Questionnaire	Modified
186286	NHDS - Pretest Survey Presentation	Other-Survey Presentation for Pretest	Modified
186285	NHDS - Hospital Interview Questionnaire	Other-Hospital Interview Questionnaire	Modified
186284	NHDS - Hospital In-house Tape or Printout Transmittal Notice	Other-Attachment G5 - Hospital In-house Tape or Printout Transmi	Modified
186283	NHDS - Alternate Procedure Hospitals Locating Medical Records Manual	Other-Attachment G4 - Hospital Manual	Modified
186282	NHDS - Primary Procedures Hospital Transmittal Notice	Other-Primary Procedures Hospitals Transmittal Notice	Modified
186281	NHDS - Primary Procedure Hospitals Sample Listing Sheet	Other-Primary Procedures Hospitals Sampling Listing Sheet	Modified

ICR Details

OMB Control No: 0920-0212	ICR Reference No: 200909-0920-005
Status: Historical Active	Previous ICR Reference No: 200808-0920-008
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Hospital Discharge Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/18/2009
	Date Received in OIRA: 09/14/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2011	10/31/2011	10/31/2011
Responses	33,755	0	33,755
Time Burden (Hours)	5,591	0	5,591
Cost Burden (Dollars)	0	0	0

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Abstract: This request is for permission to collect data for the current National Hospital Discharge Survey in 2010. The currently approved plan was to end in 2009, with a redesigned survey beginning in 2010. Budget constraints make it necessary to keep the current survey in the field through 2010 until the redesigned survey can be integrated in 2011. There is no change in burden.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

table that charts list of burden

IC Title	Form No.	Form Name
NHDS - Medical abstract form
NHDS - Primary Procedure Hospitals Sample Listing Sheet
NHDS - Primary Procedures Hospital Transmittal Notice
NHDS - Alternate Procedure Hospitals Locating Medical Records Manual
NHDS - Hospital In-house Tape or Printout Transmittal Notice
NHDS - Hospital Interview Questionnaire
NHDS - Pretest Survey Presentation
NHDS - Pretest Facility Questionnaire
NHDS - Pretest Sample Listing Sheet
NHDS - Pretest Verify Sampling and Reabstract
NHDS - Pretest Debrief Hospital Staff Guide
MHDS - 2010 & 2011 Survey Presentation to Hospitals
NHDS - 2010 & 2011 Facility Questionnaire
NHDS - 2010 & 2011 Sample listing sheet
NHDS - 2010 & 2011 Verify Sampling and Reabstract

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	33,755	33,755	0	0	0	0
Annual Time Burden (Hours)	5,591	5,591	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $4,461,112

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/14/2009

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