2016 Ambulatory Surgery Center Patient Record Form

National Hospital Ambulatory Medical Care Survey

OMB: 0920-0278

IC ID: 214304

Information Collection (IC) Details

View Information Collection (IC)

2016 Ambulatory Surgery Center Patient Record Form
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0278 Attachment D - 2016 NHAMCS ASL PRF Changes Attachment D - 2016 NHAMCS ASL PRF Changes.pdf Yes Yes Fillable Printable
Instruction Attachment H - 2016 NHAMCS ASL PRF Sample Card.pdf Yes Yes Fillable Printable

Health Public Health Monitoring

Health Resources Utilization Statistics (09-20-0167)  49 FR 37693

23 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 2,300 -2,300 0 0
Annual IC Time Burden (Hours) 0 0 268 -268 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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