Information Collection

Hospital Induction Interview 2020

IC 214297 under ICR 202004-0920-006 · OMB 0920-0278.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0278 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Hospital Induction Interview 2020	Form and Instruction
Hospital induction questionnaire 2020 Attachment C1 - Induction questionnaire (2020) 04.09.2020.docx	Form and Instruction

IC Title:

Hospital Induction Interview 2020

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 and Instruction	none	Hospital induction questionnaire 2020	Attachment C1 - Induction questionnaire (2020) 04.09.2020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health Resources Utilization Statistics (09-20-0167)

FR Citation: 49 FR 37693

Number of Respondents: 137

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	137	24	113
Annual IC Time Burden (Hours)	69	-16	85
Annual IC Cost Burden (Dollars)	8,041	122	7,919

Documents for IC

table that charts IC Documents
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.