Information Collection

RCC/ADSC Sampling and Services User Questionnaire

IC 231012 under ICR 202007-0920-018 · OMB 0920-0943.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0943 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0943 RCC/ADSC Sampling and Services User Questionnaire	Form and Instruction
0920-0943 RCC/ADSC Sampling and Services User Questionnaire Attachment C-3 011018.docx	Form and Instruction

IC Title:

RCC/ADSC Sampling and Services User Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	0920-0943	RCC/ADSC Sampling and Services User Questionnaire	Attachment C-3 011018.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Health Resources Utilization Statistics

FR Citation: 49 FR 37697

Number of Respondents: 3,008

Number of Respondents for Small Entity: 1,430

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-3,008	3,008
Annual IC Time Burden (Hours)	-1,504	1,504
Annual IC Cost Burden (Dollars)	0	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.