Information Collection

NHDS Facility Questionaire Part A - D

IC 186281 under ICR 201102-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Att E Facility Questionnaire rev.101310.docx	Other-WORD
Att M FAQs about the NHDS 11032010.docx Att M FAQs about the NHDS 11032010	IC Document

IC Title:

NHDS Facility Questionaire Part A - D

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-WORD			Att E Facility Questionnaire rev.101310.docx		Yes	Yes	Fillable Printable

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: 167

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	167	11	156
Annual IC Time Burden (Hours)	668	603	65
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att M FAQs about the NHDS 11032010	Att M FAQs about the NHDS 11032010.docx	01/05/2011

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