Information Collection

Health Information National Trends Survey

IC 215033 under ICR 201502-0925-003 · OMB 0925-0538.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0538 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 B1- Instrument in English Health Information National Trends Survey	Form and Instruction
1 B1- Instrument in English B1 - Instrument in English.docx	Form and Instruction
B2 - Instrument in Spanish.docx B2 Instrument in Spanish	IC Document

IC Title:

Health Information National Trends Survey

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
Form and Instruction	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,318

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	4,318	4,318
Annual IC Time Burden (Hours)	2,159	2,159
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
B2 Instrument in Spanish		02/18/2015

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

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