Information Collection

Ambulatory Unit Record

IC 43613 under ICR 201105-0920-007 · OMB 0920-0278.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0278 can be found here:

Documents and Forms

Document Name Document Type
Form unnumbered Ambulatory Unit Record Form
unnumbered Att. J. Ambulatory Unit Induction Form NHAMCS2010 Attachment J - NHAMCS-101U.pdf Form
Att. J. Ambulatory Unit Induction Form - 11/29/2010 nhamcs101u.pdf Form
Ambulatory Unit Induction - 5/2011 Attachment C - NHAMCS-101(U).pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ambulatory Unit Record	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	unnumbered	Att. J. Ambulatory Unit Induction Form	NHAMCS2010 Attachment J - NHAMCS-101U.pdf	Yes	Yes	Paper Only
Form	none	Att. J. Ambulatory Unit Induction Form - 11/29/2010	nhamcs101u.pdf	Yes	Yes	Paper Only
Form	none	Ambulatory Unit Induction - 5/2011	Attachment C - NHAMCS-101(U).pdf	Yes	No	Paper Only

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: 1,827	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 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,827	48	1,779
Annual IC Time Burden (Hours)	1,827	48	1,779
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.