Information Collection

NEHRS Supplement - Electronic Respondents

IC 227140 under ICR 201712-0920-011 · OMB 0920-1015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1015 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NEHRS Supplement - Electronic Respondents	Form and Instruction
NEHRS Supplement - Electronic Respondents Att F1 - NEHRS Supp Elec Resp- hie.pdf	Form and Instruction

IC Title:

NEHRS Supplement - Electronic Respondents

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	NA	NEHRS Supplement - Electronic Respondents	Att F1 - NEHRS Supp Elec Resp- hie.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0167 Health Resources Utilization Statistics

FR Citation: 49 FR 37693

Number of Respondents: 858

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 30 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	858	858
Annual IC Time Burden (Hours)	286	286
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.