Information Collection Request

National Hospital Care Survey

ICR 201901-0920-008 · OMB 0920-0212 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-0212 Initial Hospital Intake Questionnaire Form and Instruction Modified Available
Form 0920-0212 Prepare and Transmit EHR for Inpatient and Ambulatory Form and Instruction Modified Repair queued
Form 0920-0212 Annual Ambulatory Hospital Interview Form and Instruction Removed Repair queued
Form 0920-0212 Annual Hospital Interview Form and Instruction Modified Repair queued
Form 0920-0212 Prepare and transmit UB-04 or State File for Inpatient and Ambulatory Form and Instruction Modified Available
Form 0920-0212 Recruitment Survey Presentation Form and Instruction Modified Available
Att M - Summary Update.docx Supplementary Document Uploaded 2019-01-29 Repair queued
Att K - Confidentiality Letter.docx Supplementary Document Uploaded 2019-01-29 Repair queued
Att G - ERB Approval Notice for NHCS.pdf Supplementary Document Uploaded 2019-01-29 Available
Att E- EHR Variable List.pdf Supplementary Document Uploaded 2019-01-29 Available
Att D - Currently Approved UB04 Data Elements.docx Supplementary Document Uploaded 2019-01-29 Available
Att C - Introductory Letter to Hospitals.docx Supplementary Document Uploaded 2019-01-29 Available
Att B2 - 60-day Federal Register Notice Comments.docx Supplementary Document Uploaded 2019-01-29 Repair queued
Att B1- 60-Day FRN for NHCS 120718.pdf Supplementary Document Uploaded 2019-01-29 Available
Att A - Legislative Authority to Collect Data on Hospital Utilization.rtf Supplementary Document Uploaded 2019-01-29 Available
0920-0212_Statement B_02.27.2019.docx Supporting Statement B Uploaded 2019-03-05 Available
0920-0212_Statement A_02.27.2019.docx Supporting Statement A Uploaded 2019-03-05 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
6666 Initial Hospital Intake Questionnaire Form and Instruction Modified
186285 Prepare and Transmit EHR for Inpatient and Ambulatory Form and Instruction Modified
186284 Annual Ambulatory Hospital Interview Form and Instruction Removed
186283 Annual Hospital Interview Form and Instruction Modified
186282 Prepare and transmit UB-04 or State File for Inpatient and Ambulatory Form and Instruction Modified
186281 Recruitment Survey Presentation Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2022 36 Months From Approved 03/31/2019
6,482 0 7,458
7,080 0 8,232
0 0 0





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 6,482 7,458 0 -976 0 0
Annual Time Burden (Hours) 7,080 8,232 0 -1,152 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No