Information Collection Request

Service Annual Survey

ICR 201606-0607-006 · OMB 0607-0422 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form SA-54150E Service Annual Survey Form Unchanged Available
Proposed SAS content for 622, Hospitals.pdf Supplementary Document Uploaded 2016-06-20 Available
Current SAS content for 622, Hospitals.pdf Supplementary Document Uploaded 2016-06-20 Available
SAS Nonsubstantive Change Request.docx Justification for No Material/Nonsubstantive Change Uploaded 2016-06-20 Available
Supporting Statement B FINAL.docx Supporting Statement B Uploaded 2015-09-18 Available
Supporting Statement A FINAL.docx Supporting Statement A Uploaded 2015-09-18 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
37149 Service Annual Survey Form Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2018 12/31/2018 12/31/2018
82,240 0 82,240
306,807 0 306,807
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
Service Annual Survey SA-48610E, SA-49000A, SA-49000E, SA-51000A, SA-51000E, SA-51111A, SA-51112A, SA-51113A, SA-51113E, SA-51114A, SA-51721E, SA-48000A, SA-48500A, SA-51111E, SA-51112E, SA-51223A, SA-51919A, SA-54131A, SA-54181A, SA-54002E, SA-56134E, SA-71120E, SA-81300E, SA-721A, SA-721B, SA-721B, SA-721F, SA-722A, SA-722E, SA-54170E, SA-54181E, SA-22010A, SA-22010E, SA-48000E, SA-48100A, SA-48100E, SA-48121A, SA-48121E, SA-48300A, SA-48300E, SA-48500E, SA-51114E, SA-48610A, SA-51118A, SA-51118E, SA-51119A, SA-51119E, SA-51120A, SA-51120E, SA-51210A, SA-51210E, SA-51213A, SA-51213E, SA-51219A, SA-51219E, SA-51222A, SA-51222E, SA-51223E, SA-51510E, SA-51520E, SA-51710A, SA-51710E, SA-51730A, SA-51730E, SA-51740E, SA-51790A, SA-51790E, SA-51820A, SA-51820E, SA-51911A, SA-51911E, SA-51912A, SA-51912E, SA-51913A, SA-51919E, SA-52000A, SA-52000E, SA-52200A, SA-52200E, SA-52311A, SA-52311E, SA-52312A, SA-52312E, SA-52390A, SA-52400A, SA-52400E, SA-53000A, SA-53000E, SA-53211A, SA-53211E, SA-54000A, SA-54000E, SA-54002A, SA-54011A, SA-54011E, SA-54131E, SA-54133A, SA-54133E, SA-54150A, SA-54150E, SA-54160A, SA-54160E, SA-54170A, SA-54182A, SA-54182E, SA-54186A, SA-54186E, SA-54210E, SA-56000A, SA-56000E, SA-56130A, SA-56130E, SA-56132A, SA-56132E, SA-56134A, SA-56150A, SA-56150E, SA-56159A, SA-56159E, SA-56210A, SA-56210E, SA-56220A, SA-56220E, SA-56291A, SA-61000A, SA-61000E, SA-62000A, SA-62150A, SA-62150E, SA-62400A, SA-71000A, SA-71000E, SA-71002A, SA-71002E, SA-71110A, SA-71120A, SA-71150A, SA-71150E, SA-71311A, SA-71311E, SA-81000A, SA-81000E, SA-81300A, SA-22130A, SA-22130E, SA-48400A, SA-48400E, SA-51224A, SA-51224E, SA-51510A, SA-51520A, SA-51721A, SA-51740A, SA-51913E, SA-52390E, SA-54210A, SA-56152A, SA-56152E, SA-56291E, SA-62000E, SA-62400E, SA-71110E Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services 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Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report ,   Annual Services Report

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 82,240 82,240 0 0 0 0
Annual Time Burden (Hours) 306,807 306,807 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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