Information Collection

Hosptial Staff Data collection

IC 190408 under ICR 201005-0990-003 · OMB 0990-0344.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0990-0344 Data Elements Hosptial Staff Data collection	Form
0990Attachment 2 HAvBED User Guide.pdf	Other-guide
0990-0344 Data Elements 0990-0344Attachment 2.doc	Form

IC Title:

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-guide			0990Attachment 2 HAvBED User Guide.pdf		No	No	Paper Only
Form	0990-0344	Data Elements	0990-0344Attachment 2.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	612,000	19,680	592,320
Annual IC Time Burden (Hours)	612,000	19,680	592,320
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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