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AIRS Hospital Discharge Reporting
Asthma Information Reporting System (AIRS)
OMB: 0920-0853
IC ID: 220723
OMB.report
HHS/CDC
OMB 0920-0853
ICR 201904-0920-002
IC 220723
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0853 can be found here:
2023-05-24 - Extension without change of a currently approved collection
2020-03-09 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-0853
AIRS Hospital Discharge Reporting
Form
0920-0853 STATE [Year] Hospital Discharge Data
Att3c_AIRS HD Reporting Forms.xlsx
Form
Att3d1_AIRS Instructions_HD_ED_Data_clean.docx
Att 3d1_Instructions How to Complete the 2014 for HD ED Data Spreadsheet Template
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
AIRS Hospital Discharge Reporting
Agency IC Tracking Number:
0920-0853
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
0920-0853
STATE [Year] Hospital Discharge Data
Att3c_AIRS HD Reporting Forms.xlsx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
25
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
25
0
2
0
0
23
Annual IC Time Burden (Hours)
13
0
1
0
0
12
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Att 3d1_Instructions How to Complete the 2014 for HD ED Data Spreadsheet Template
Att3d1_AIRS Instructions_HD_ED_Data_clean.docx
04/04/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.