Information Collection

2011 mPINC Survey for Hospitals

IC 179025 under ICR 201106-0920-005 · OMB 0920-0743.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0743 can be found here:

Documents and Forms

Document Name Document Type
2011 mPINC Survey for Hospitals Form
Hospital Survey App H-1_2011 mPINC Survey for Hospitals REVISED 5 27 2011.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2011 mPINC Survey for Hospitals	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
Form	none	Hospital Survey	App H-1_2011 mPINC Survey for Hospitals REVISED 5 27 2011.docx		No	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,568	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 25 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,568	2,568
Annual IC Time Burden (Hours)	1,284	1,284
Annual IC Cost Burden (Dollars)	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.