Information Collection

NEHRS Supplement - Electronic Respondents

IC 227140 under ICR 201911-0920-005 · OMB 0920-1015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1015 can be found here:

Documents and Forms

Document Name Document Type
NEHRS Supplement - Electronic Respondents Form and Instruction
NEHRS Supplement - Electronic Respondents Att F1 - NEHRS Supp Elec Resp- hie.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NEHRS Supplement - Electronic Respondents	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	NEHRS Supplement - Electronic Respondents	Att F1 - NEHRS Supp Elec Resp- hie.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 858	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 30 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-858	858
Annual IC Time Burden (Hours)	-286	286
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.