Information Collection

TEDS Admission Data

IC 204348 under ICR 201901-0930-005 · OMB 0930-0335.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0335 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TEDS Tables TEDS Admission Data	Form and Instruction
TEDS Tables TEDS Tables Attachment A2 - 2019 TEDS - Table of TEDS Reporting Practices by State 1.30.19.pdf	Form and Instruction
SABG Tables SABG Tables Attachment A3 - 2019 TEDS - SABG Application Tables 14-20 1.30.19.pdf	Form and Instruction

IC Title:

TEDS Admission Data

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	TEDS Tables	TEDS Tables	Attachment A2 - 2019 TEDS - Table of TEDS Reporting Practices by State 1.30.19.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	SABG Tables	SABG Tables	Attachment A3 - 2019 TEDS - SABG Application Tables 14-20 1.30.19.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	208	208
Annual IC Time Burden (Hours)	1,300	1,300
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.