Information Collection

Admission and Discharge Data Elements

IC 204348 under ICR 201210-0930-001 · OMB 0930-0335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0335 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A1 - TEDS data elements.docx	Other-List Data Elements
Attachment A3 - SAPT application tables 16-22.pdf Application Tables	IC Document
Attachment A2 - TEDS reporting practices.pdf Reporting Practices	IC Document
Attachment A4 - Participant list March 2011.pdf List Regional Meeting	IC Document
Attachment A5 - Participant list May 2012.pdf List Expert Panel	IC Document

IC Title:

Admission and Discharge Data Elements

Agency IC Tracking Number:

Is this a Common Form? No

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
Other-List Data Elements			Attachment A1 - TEDS data elements.docx		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

Number of Respondents for Small Entity: 52

Affected Public: State, Local, and Tribal Governments

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	416	416
Annual IC Time Burden (Hours)	3,016	3,016
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Application Tables	Attachment A3 - SAPT application tables 16-22.pdf	09/14/2012
Reporting Practices	Attachment A2 - TEDS reporting practices.pdf	09/14/2012
List Regional Meeting	Attachment A4 - Participant list March 2011.pdf	09/14/2012
List Expert Panel	Attachment A5 - Participant list May 2012.pdf	09/14/2012

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