Information Collection

Future of MONAHRQ® Survey 2014: Current and Potential Host Users

IC 212537 under ICR 201104-0935-006 · OMB 0935-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0179 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Future of MONAHRQ® Survey 2014: Current and Potential Host Users	Form and Instruction
1 Attachment A – Approach Document—Future of MONAHRQ® Surv Approach Document_Future of MONAHRQ Survey_2014-07-08 Final.docx	Form and Instruction
Future of MONAHRQ 2014_OMB Submission Form_2014-07-08c.docx Supporting Statement	IC Document
OMB Cover Letter.doc Cover Page	IC Document
OMB Cover Letter.doc Cover Page	IC Document

IC Title:

Future of MONAHRQÂ® Survey 2014: Current and Potential Host Users

Agency IC Tracking Number:

IC Status: New

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
Form and Instruction	1	Attachment A â Approach DocumentâFuture of MONAHRQÂ® Survey 2014	Approach Document_Future of MONAHRQ Survey_2014-07-08 Final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,205

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,205	2,205
Annual IC Time Burden (Hours)	551	551
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	Future of MONAHRQ 2014_OMB Submission Form_2014-07-08c.docx	07/30/2014
Cover Page	OMB Cover Letter.doc	07/30/2014
Cover Page	OMB Cover Letter.doc	07/30/2014

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