Information Collection

Hospital -Based Laboratories

IC 204573 under ICR 201301-0955-001 · OMB 0955-0014.

Documents and Forms

Document Name Document Type
0955-0014 NSHIE Quex Version A_Hospitals_1_17_2013.pdf Other-survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Hospital -Based Laboratories	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
Other-survey			0955-0014 NSHIE Quex Version A_Hospitals_1_17_2013.pdf		No	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,729	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,729	2,729
Annual IC Time Burden (Hours)	910	910
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.