Information Collection

Hospital Induction Interview 2021

IC 233075 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⚠️ Notice: This information collection may be referencing outdated material.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 2021	Form and Instruction
2021 NHAMCS Hospital Induction Questionnaire Attachment C3 - Induction questionnaire (2021) 08.19.2020.docx	Form and Instruction

IC Title:

Hospital Induction Interview 2021

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	NA	2021 NHAMCS Hospital Induction Questionnaire	Attachment C3 - Induction questionnaire (2021) 08.19.2020.docx	NA	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: 410

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	410	183	227
Annual IC Time Burden (Hours)	205	91	114
Annual IC Cost Burden (Dollars)	24,063	24,063	0

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.