Information Collection

Hospital Induction Interview 2019-2020

IC 233075 under ICR 201809-0920-005 · OMB 0920-0278.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0278 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0278 Hospital Induction Interview 2019-2020	Form and Instruction
0920-0278 2019-2020 Hospital Induction Interview Attachment B - 2019 NHAMCS Hospital Induction form 083118.pdf	Form and Instruction

IC Title:

Hospital Induction Interview 2019-2020

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	0920-0278	2019-2020 Hospital Induction Interview	Attachment B - 2019 NHAMCS Hospital Induction form 083118.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health Resources Utilization Statistics (09-20-0167)

FR Citation: 49 FR 37693

Number of Respondents: 227

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	227	227
Annual IC Time Burden (Hours)	114	114
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.