Information Collection

National Hospital Care Survey (Abstraction Form)

IC 240789 under ICR 202003-0920-011 · OMB 0920-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0212 National Hospital Care Survey (Abstraction Form)	Form
0920-0212 Validation of Enhanced Algorithms to Identify Opioid Use Abstraction Form_03_13_2020_FINAL_OMB.docx	Form
Nonsubstantive Change PCORTF_Opioid_03_16_2020.docx Request for Change	IC Document

IC Title:

National Hospital Care Survey (Abstraction Form)

Agency IC Tracking Number:

0920-0212-20LO

Is this a Common Form? No

IC Status: New

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	0920-0212	Validation of Enhanced Algorithms to Identify Opioid Use and Co-Occurring Disorders in National Hospital Care Survey (NHCS)	Abstraction Form_03_13_2020_FINAL_OMB.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0167 Health Resources Utilization Statistics

FR Citation: 83 FR 37693

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Change	Nonsubstantive Change PCORTF_Opioid_03_16_2020.docx	04/29/2020

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