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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.