NHDS Facility Questionaire Part A - D

National Hospital Care Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0212 can be found here:

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	167	167
Annual IC Time Burden (Hours)	668	668
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.