Information Collection

Introduction Interview - Service Delivery Site (NAMCS-201)

IC 220058 under ICR 201702-0920-007 · OMB 0920-0234.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0234 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0234 Introduction Interview - Service Delivery Site (NAMCS-201)	Form and Instruction
0920-0234 Att C4- 2016 NAMCS-201 Att C4- 2016 NAMCS-201 122115.docx	Form and Instruction

IC Title:

Introduction Interview - Service Delivery Site (NAMCS-201)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

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 and Instruction	0920-0234	Att C4- 2016 NAMCS-201	Att C4- 2016 NAMCS-201 122115.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health Resources Utilzation 09-20-0167

FR Citation: 49 FR 37697

Number of Respondents: 104

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	104	104
Annual IC Time Burden (Hours)	52	52
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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