National Hospital Discharge Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment K Updated Induction Letter for the 2011-2013 NHCS.pdf	Supplementary Document	Uploaded 2011-04-06	Available
Attachment D Updated ERB Approval Letter for NHCS.pdf	Supplementary Document	Uploaded 2011-04-06	Available
NHCS 2011-2013 Updated Supporting Statement Part B cjd 4-4-11 v2.docx	Supporting Statement B	Uploaded 2011-04-06	Available
Att K Induction Letter for NHDS 110410.docx	Supplementary Document	Uploaded 2011-01-05	Available
Att C List of Experts Consulted.doc	Supplementary Document	Uploaded 2011-01-05	Available
Att A Legislative Authority.rtf	Supplementary Document	Uploaded 2011-01-05	Available
Att B 60d FRN_0212.pdf	Supplementary Document	Uploaded 2011-01-05	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
Att L List of UB04 Data Elements.docx	Supplementary Document	Uploaded 2011-01-05	Available
Att M FAQs about the NHDS 11032010.docx	Supplementary Document	Uploaded 2011-01-05	Available
NHCS 2011-2013 Updated Sup Sta Part A cjd 4-04-11 .docx	Supporting Statement A	Uploaded 2011-04-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6666	Abstraction and Reabstraction for the ACS module of the NHDS	Other-Word	Modified
186294	NHDS - 2010 & 2011 Verify Sampling and Reabstract	Other-2010 & 2011 Verify Sample and Reabstraction	Removed
186293	NHDS - 2010 & 2011 Sample listing sheet	Other-2010 & 2011 Sample listing sheet	Removed
186292	NHDS - 2010 & 2011 Facility Questionnaire	Other-Facility Questionnaire	Removed
186291	MHDS - 2010 & 2011 Survey Presentation to Hospitals	Other-2010 & 2011 Survey Presentation to Hospitals	Removed
186290	NHDS - Pretest Debrief Hospital Staff Guide	Other-Pretest Debrief Hospital Staff Guide	Removed
186289	NHDS - Pretest Verify Sampling and Reabstract	Other-Pretest Verify Sampling and Reabstract	Removed
186288	NHDS - Pretest Sample Listing Sheet	Other-Pretest Sample Listing Sheet	Removed
186287	NHDS - Pretest Facility Questionnaire	Other-Pretest Facililty Questionnaire	Removed
186286	NHDS - Pretest Survey Presentation	Other-Survey Presentation for Pretest	Removed
186285	NHDS Survey Presentation for the ACS (Interview w/Hospital Executive and Staff)	Other-Word	Modified
186284	Quarterly Transmission of UB -04 Data	Other-WORD	Modified
186283	NHDS Survey Presentation	Other-Word	Modified
186282	Post Induction - Facility Questionnaire (Part D)	Other-WORD	Modified
186281	NHDS Facility Questionaire Part A - D	Other-WORD	Modified

ICR Details

OMB Control No: 0920-0212	ICR Reference No: 201102-0920-003
Status: Historical Active	Previous ICR Reference No: 200909-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: National Hospital Discharge Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/06/2011
	Date Received in OIRA: 02/01/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	36 Months From Approved	10/31/2011
Responses	2,711	0	33,755
Time Burden (Hours)	3,520	0	5,591
Cost Burden (Dollars)	0	0	0

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Abstract: The current NHDS is scheduled to expire with the 2010 data collection. Clearance is now being sought to field a new NHDS, scheduled to begin in 2011 with the recruitment of approximately 500 hospitals and collecting data on hospital inpatients for all discharges from those hospitals in 2011 continuing through 2013. Hospitals recruited from the NHDS will provide data on hospital inpatients from their Uniform Bill (UB)-04 administrative databases. This is a departure from the current NHDS by moving to an electronic system for collection of core data while providing a flexible platform that allows for primary data collection from the medical record for strategic samples of cases. In addition, facility level data will be collected through a facility questionnaire.

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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
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 48348	08/10/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 559	01/05/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
NHDS - 2010 & 2011 Verify Sampling and Reabstract
Abstraction and Reabstraction for the ACS module of the NHDS
NHDS Facility Questionaire Part A - D
Post Induction - Facility Questionnaire (Part D)
NHDS Survey Presentation
Quarterly Transmission of UB -04 Data
NHDS Survey Presentation for the ACS (Interview w/Hospital Executive and Staff)
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

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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	2,711	33,755	0	-32,696	1,652	0
Annual Time Burden (Hours)	3,520	5,591	0	-3,996	1,925	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Changing Forms

Short Statement: NHDS will institute a new version, which will no longer use average length of stay as an exclusion criterion. It is based on list, rather than a cluster sample of hospitals. Thus eliminating the area PSU stage of sampling. This is a revision of a currently approved collection.

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Annual Cost to Federal Government: $3,900,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 01/27/2011

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