Information Collection

AIRS Hospital Discharge Reporting

IC 220723 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
AIRS Hospital Discharge Reporting	Form
AIRS Hospital Discharge Reporting Att3c AIRS HD Reporting Forms 20160317.xlsx	Form
Att3d2 AIRS Instructions_HD_ED_HowtoDocSharing 20160317.docx AIRS HD Reporting Instructions	IC Document

IC Title:

AIRS Hospital Discharge 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	AIRS Hospital Discharge Reporting	Att3c AIRS HD Reporting Forms 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 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
AIRS HD Reporting Instructions	Att3d2 AIRS Instructions_HD_ED_HowtoDocSharing 20160317.docx	03/22/2016

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