Information Collection

AIRS Emergency Department Visits Reporting

IC 220722 under ICR 201603-0920-010 · OMB 0920-0853.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0853 can be found here:

Documents and Forms

Document Name Document Type
AIRS Emergency Department Visits Reporting Form
AIRS Emergency Department Visits Reporting Att3b AIRS ED Visits Reporting Form 20160317.xlsx Form
Att3d1 AIRS Instructions_HD_ED_Data 20160317.docx AIRS ED Reporting Instructions IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	AIRS Emergency Department Visits Reporting	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	AIRS Emergency Department Visits Reporting	Att3b AIRS ED Visits Reporting Form 20160317.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23	Number of Respondents for Small Entity: 0

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	23	23
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
AIRS ED Reporting Instructions	Att3d1 AIRS Instructions_HD_ED_Data 20160317.docx	03/22/2016

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