Information Collection

Ambulatory Unit Record

IC 43613 under ICR 201106-0920-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	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

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: 1,779

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	Previously Approved
Annual Number of Responses for this IC	1,779	1,779
Annual IC Time Burden (Hours)	1,779	1,779
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.