Prepare and Transmit EHR for Inpatient and Ambulatory

National Hospital Care Survey

OMB: 0920-0212

IC ID: 186285

Information Collection (IC) Details

View Information Collection (IC)

Prepare and Transmit EHR for Inpatient and Ambulatory
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0212 Att W - Qtr Data Trans of EHR Data Att W - Qtr Data Trans of EHR Data.doc No   Fillable Printable

Health Public Health Monitoring

09-20-0167 Health Resources Utilization Statistics  49 FR 37693

100 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 400 0 -1,600 0 0 2,000
Annual IC Time Burden (Hours) 400 0 -1,600 0 0 2,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att Q - UB-04 Data Elements Attachment Q- List of UB04 Data Elements.docx 01/31/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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