Attachment D: Hospital Information Submission Form

Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) Survey Database

OMB: 0935-0243

IC ID: 235458

Information Collection (IC) Details

View Information Collection (IC)

Attachment D: Hospital Information Submission Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 3 Attachment D: Hospital Information Submission Form Attachment D Hospital Information Submission Form_updated 7-15-19_.docx Yes Yes Fillable Fileable

Health Health Care Services

 

300 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 300 0 300 0 0 0
Annual IC Time Burden (Hours) 25 0 25 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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