Information Collection

Documentation of information of deaths related to 2 point soft wrist restaints

IC 236196 under ICR 201905-0938-011 · OMB 0938-1210.

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Information Collection (IC) Details

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IC Title:	Documentation of information of deaths related to 2 point soft wrist restaints	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 482 section 13

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Automated Survey Processing Environment (ASPEN)	FR Citation: 71 FR 29644

Number of Respondents: 2,556	Number of Respondents for Small Entity: 1,917

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,556	2,556
Annual IC Time Burden (Hours)	426	426
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.