Information Collection

57.116 Denominators for Neonatal Intensive Care Unit (NICU)

IC 183554 under ICR 201308-0920-010 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.116 57.116 Denominators for Neonatal Intensive Care Unit (NICU)	Form
57.116 Denominators for the Neonatal Intensive Care Unit 57.116_DenominatorNICU_BLANK.DOCX	Form

IC Title:

57.116 Denominators for Neonatal Intensive Care Unit (NICU)

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	57.116	Denominators for the Neonatal Intensive Care Unit	57.116_DenominatorNICU_BLANK.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,000

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	54,000	0	54,000
Annual IC Time Burden (Hours)	162,000	0	162,000
Annual IC Cost Burden (Dollars)	5,099,760	5,099,760	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.