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-81300E Annual Services Report Form Unchanged Available
Form SA-81300A Annual Services Report Form Unchanged Available
Form SA-81000E Annual Services Report Form Unchanged Available
Form SA-81000A Annual Services Report Form Unchanged Available
Form SA-71311E Annual Services Report Form Unchanged Available
Form SA-71311A Annual Services Report Form Unchanged Available
Form SA-71150E Annual Services Report Form Unchanged Available
Form SA-71150A Annual Services Report Form Unchanged Available
Form SA-71120E Annual Services Report Form Unchanged Available
Form SA-71120A Annual Services Report Form Unchanged Available
Form SA-71110E Annual Services Report Form Unchanged Available
Form SA-71110A Annual Services Report Form Unchanged Available
Form SA-71002E Annual Services Report Form Unchanged Available
Form SA-71002A Annual Services Report Form Unchanged Available
Form SA-71000E Annual Services Report Form Unchanged Available
Form SA-71000A Annual Services Report Form Unchanged Available
Form SA-62400E Annual Services Report Form Unchanged Available
Form SA-62400A Annual Services Report Form Unchanged Available
Form SA-62150E Annual Services Report Form Unchanged Available
Form SA-62150A Annual Services Report Form Unchanged Available
Form SA-62000E Annual Services Report Form Unchanged Available
Form SA-62000A Annual Services Report Form Unchanged Available
Form SA-61000E Annual Services Report Form Unchanged Available
Form SA-61000A Annual Services Report Form Unchanged Available
Form SA-56291E Annual Services Report Form Unchanged Available
Form SA-56291A Annual Services Report Form Unchanged Available
Form SA-56220E Annual Services Report Form Unchanged Available
Form SA-56220A Annual Services Report Form Unchanged Available
Form SA-56210E Annual Services Report Form Unchanged Available
Form SA-56210A Annual Services Report Form Unchanged Available
Form SA-56159E Annual Services Report Form Unchanged Available
Form SA-56159A Annual Services Report Form Unchanged Available
Form SA-56152E Annual Services Report Form Unchanged Available
Form SA-56152A Annual Services Report Form Unchanged Available
Form SA-56150E Annual Services Report Form Unchanged Available
Form SA-56150A Annual Services Report Form Unchanged Available
Form SA-56134E Annual Services Report Form Unchanged Available
Form SA-56134A Annual Services Report Form Unchanged Available
Form SA-56132E Annual Services Report Form Unchanged Available
Form SA-56132A Annual Services Report Form Unchanged Available
Form SA-56130E Annual Services Report Form Unchanged Available
Form SA-56130A Annual Services Report Form Unchanged Available
Form SA-56000E Annual Services Report Form Unchanged Available
Form SA-56000A Annual Services Report Form Unchanged Available
Form SA-54210E Annual Services Report Form Unchanged Available
Form SA-54210A Annual Services Report Form Unchanged Available
Form SA-54186E Annual Services Report Form Unchanged Available
Form SA-54186A Annual Services Report Form Unchanged Available
Form SA-54182E Annual Services Report Form Unchanged Available
Form SA-54182A Annual Services Report Form Unchanged Available
Form SA-54181E Annual Services Report Form Unchanged Available
Form SA-54181A Annual Services Report Form Unchanged Available
Form SA-54170E Annual Services Report Form Unchanged Available
Form SA-54170A Annual Services Report Form Unchanged Available
Form SA-54160E Annual Services Report Form Unchanged Available
Form SA-54160A Annual Services Report Form Unchanged Available
Form SA-54150A Annual Services Report Form Unchanged Available
Form SA-54133E Annual Services Report Form Unchanged Available
Form SA-54133A Annual Services Report Form Unchanged Available
Form SA-54131E Annual Services Report Form Unchanged Available
Form SA-54131A Annual Services Report Form Unchanged Available
Form SA-54011E Annual Services Report Form Unchanged Available
Form SA-54011A Annual Services Report Form Unchanged Available
Form SA-54002E Annual Services Report Form Unchanged Available
Form SA-54002A Annual Services Report Form Unchanged Available
Form SA-54000E Annual Services Report Form Unchanged Available
Form SA-54000A Annual Services Report Form Unchanged Available
Form SA-53211E Annual Services Report Form Unchanged Available
Form SA-53211A Annual Services Report Form Unchanged Available
Form SA-53000E Annual Services Report Form Unchanged Available
Form SA-53000A Annual Services Report Form Unchanged Available
Form SA-52400E Annual Services Report Form Unchanged Available
Form SA-52400A Annual Services Report Form Unchanged Available
Form SA-52390E Annual Services Report Form Unchanged Available
Form SA-52390A Annual Services Report Form Unchanged Available
Form SA-52312E Annual Services Report Form Unchanged Available
Form SA-52312A Annual Services Report Form Unchanged Available
Form SA-52311E Annual Services Report Form Unchanged Available
Form SA-52311A Annual Services Report Form Unchanged Available
Form SA-52200E Annual Services Report Form Unchanged Available
Form SA-52200A Annual Services Report Form Unchanged Available
Form SA-52000E Annual Services Report Form Unchanged Available
Form SA-52000A Annual Services Report Form Unchanged Available
Form SA-51919E Annual Services Report Form Unchanged Available
Form SA-51919A Annual Services Report Form Unchanged Available
Form SA-51913E Annual Services Report Form Unchanged Available
Form SA-51913A Annual Services Report Form Unchanged Available
Form SA-51912E Annual Services Report Form Unchanged Available
Form SA-51912A Annual Services Report Form Unchanged Available
Form SA-51911E Annual Services Report Form Unchanged Available
Form SA-51911A Annual Services Report Form Unchanged Available
Form SA-51820E Annual Services Report Form Unchanged Available
Form SA-51820A Annual Services Report Form Unchanged Available
Form SA-51790E Annual Services Report Form Unchanged Available
Form SA-51790A Annual Services Report Form Unchanged Available
Form SA-51740E Annual Services Report Form Unchanged Available
Form SA-51740A Annual Services Report Form Unchanged Available
Form SA-51730E Annual Services Report Form Unchanged Available
Form SA-51730A Annual Services Report Form Unchanged Available
Form SA-51721E Annual Services Report Form Unchanged Available
Form SA-51721A Annual Services Report Form Unchanged Available
Form SA-51710E Annual Services Report Form Unchanged Available
Form SA-51710A Annual Services Report Form Unchanged Available
Form SA-51520E Annual Services Report Form Unchanged Available
Form SA-51520A Annual Services Report Form Unchanged Available
Form SA-51510E Annual Services Report Form Unchanged Available
Form SA-51510A Annual Services Report Form Unchanged Available
Form SA-51224E Annual Services Report Form Unchanged Available
Form SA-51224A Annual Services Report Form Unchanged Available
Form SA-51223E Annual Services Report Form Unchanged Available
Form SA-51223A Annual Services Report Form Unchanged Available
Form SA-51222E Annual Services Report Form Unchanged Available
Form SA-51222A Annual Services Report Form Unchanged Available
Form SA-51219E Annual Services Report Form Unchanged Available
Form SA-51219A Annual Services Report Form Unchanged Available
Form SA-51213E Annual Services Report Form Unchanged Available
Form SA-51213A Annual Services Report Form Unchanged Available
Form SA-51210E Annual Services Report Form Unchanged Available
Form SA-51210A Annual Services Report Form Unchanged Available
Form SA-51120E Annual Services Report Form Unchanged Available
Form SA-51120A Annual Services Report Form Unchanged Available
Form SA-51119E Annual Services Report Form Unchanged Available
Form SA-51119A Annual Services Report Form Unchanged Available
Form SA-51118E Annual Services Report Form Unchanged Available
Form SA-51118A Annual Services Report Form Unchanged Available
Form SA-51114E Annual Services Report Form Unchanged Available
Form SA-51114A Annual Services Report Form Unchanged Available
Form SA-51113E Annual Services Report Form Unchanged Available
Form SA-51113A Annual Services Report Form Unchanged Available
Form SA-51112E Annual Services Report Form Unchanged Available
Form SA-51112A Annual Services Report Form Unchanged Available
Form SA-51111E Annual Services Report Form Unchanged Available
Form SA-51111A Annual Services Report Form Unchanged Available
Form SA-51000E Annual Services Report Form Unchanged Available
Form SA-51000A Annual Services Report Form Unchanged Available
Form SA-49000E Annual Services Report Form Unchanged Available
Form SA-49000A Annual Services Report Form Unchanged Available
Form SA-48610E Annual Services Report Form Unchanged Available
Form SA-48610A Annual Services Report Form Unchanged Available
Form SA-48500E Annual Services Report Form Unchanged Available
Form SA-48500A Annual Services Report Form Unchanged Repair queued
Form SA-48400E Annual Services Report Form Unchanged Available
Form SA-48400A Annual Services Report Form Unchanged Available
Form SA-48300E Annual Services Report Form Unchanged Available
Form SA-48300A Annual Services Report Form Unchanged Available
Form SA-48121E Annual Services Report Form Unchanged Available
Form SA-48121A Annual Services Report Form Unchanged Available
Form SA-48100E Annual Services Report Form Unchanged Available
Form SA-48100A Annual Services Report Form Unchanged Available
Form SA-48000E Annual Services Report Form Unchanged Available
Form SA-48000A Annual Services Report Form Unchanged Available
Form SA-22130E Annual Services Report Form Unchanged Available
Form SA-22130A Annual Services Report Form Unchanged Available
Form SA-22010E Annual Services Report Form Unchanged Available
Form SA-22010A Annual Services Report Form Unchanged Available
Form SA-722E Annual Services Report Form Unchanged Available
Form SA-722A Annual Services Report Form Unchanged Available
Form SA-721F Annual Services Report Form Unchanged Available
Form SA-721B Annual Services Report Form Unchanged Available
Form SA-721B Annual Services Report Form Unchanged Available
Form SA-721A Annual Services Report Form Unchanged Available
Form SA-54150E Annual Services Report 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 Other-Initial Letter Unchanged
37149 Service Annual Survey Form UnchangedAnnual Services Report
37149 Service Annual Survey Form UnchangedAnnual Services Report
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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





Reginfo record details
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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-54186A, SA-54182E, SA-54186E, SA-54210E, SA-56000A, SA-56000E, SA-56132E, SA-56130A, SA-56130E, SA-56132A, 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 ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,  

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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