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Ambulatory Induction
Ambulatory Care Pretest: National Hospital Care Survey
OMB: 0920-0944
IC ID: 202430
OMB.report
HHS/CDC
OMB 0920-0944
ICR 201205-0920-009
IC 202430
( )
Documents and Forms
Document Name
Document Type
Form 3
Ambulatory Induction
Form
3 Ambulatory Unit Induction Form
Att I Ambulatory Unit Induction.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Ambulatory Induction
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
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
3
Ambulatory Unit Induction Form
Att I Ambulatory Unit Induction.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
Health Resources Utilization Statistics
FR Citation:
49 FR 37693
Number of Respondents:
140
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:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
140
0
140
0
0
0
Annual IC Time Burden (Hours)
35
0
35
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.
