National Hospital Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0212 Initial Hospital Intake Questionnaire 2019	Form and Instruction	Unchanged	Available
Form 0920 Annual Hospital Interview (revised)	Form	New	Repair queued
Form 0920-0212 Validation of Enhanced Algorithms to Identify Opioid Use and Co-Occurring Disorders in National Hospital Care Survey (NHCS)	Form	Unchanged	Available
Form 0920-0212 EHR for Inpatient and Ambulatory (quarterly)	Form and Instruction	Unchanged	Available
Form 0920-0212 Annual Hospital Interview 2019	Form and Instruction	Unchanged	Available
Form 0920-0212 UB-04 or State File for Inpatient and Ambulatory (monthly)	Form and Instruction	Unchanged	Available
Form 0920-0212 Recruitment Survey Presentation 2019	Form and Instruction	Unchanged	Available
0920-0212_Statement A_COVID-nonsub_09.08.2020.docx	Supplementary Document	Uploaded 2020-09-17	Available
COVID-19 OMB Memo_NHCS.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-09-17	Available
Nonsubstantive Change PCORTF_Opioid_04_08_2020 SK.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-04-30	Available
Att M - Summary Update.docx	Supplementary Document	Uploaded 2019-01-29	Available
Att K - Confidentiality Letter.docx	Supplementary Document	Uploaded 2019-01-29	Available
Att G - ERB Approval Notice for NHCS.pdf	Supplementary Document	Uploaded 2019-01-29	Available
Att E- EHR Variable List.pdf	Supplementary Document	Uploaded 2019-01-29	Available
Att D - Currently Approved UB04 Data Elements.docx	Supplementary Document	Uploaded 2019-01-29	Available
Att C - Introductory Letter to Hospitals.docx	Supplementary Document	Uploaded 2019-01-29	Available
Att B2 - 60-day Federal Register Notice Comments.docx	Supplementary Document	Uploaded 2019-01-29	Available
Att B1- 60-Day FRN for NHCS 120718.pdf	Supplementary Document	Uploaded 2019-01-29	Available
Att A - Legislative Authority to Collect Data on Hospital Utilization.rtf	Supplementary Document	Uploaded 2019-01-29	Available
0920-0212_Statement B_02.27.2019.docx	Supporting Statement B	Uploaded 2019-03-05	Available
0920-0212_Statement A_02.27.2019.docx	Supporting Statement A	Uploaded 2019-03-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6666	Initial Hospital Intake Questionnaire	Form and Instruction	Unchanged	Initial Hospital Intake Questionnaire 2019
243666	Annual Hospital Interview (Revised)	Form	New	Annual Hospital Interview (revised)
241648	PCORFIT Telephone Script	Other-WORD	Unchanged
240789	National Hospital Care Survey (Abstraction Form)	Form	Unchanged	Validation of Enhanced Algorithms to Identify Opioid Use and Co-Occurring Disorders in National Hospital Care Survey (NHCS)
186285	Prepare and Transmit EHR for Inpatient and Ambulatory	Form and Instruction	Unchanged	EHR for Inpatient and Ambulatory (quarterly)
186283	Annual Hospital Interview	Form and Instruction	Unchanged	Annual Hospital Interview 2019
186282	Prepare and transmit UB-04 or State File for Inpatient and Ambulatory	Form and Instruction	Unchanged	UB-04 or State File for Inpatient and Ambulatory (monthly)
186281	Recruitment Survey Presentation	Form and Instruction	Unchanged	Recruitment Survey Presentation 2019

ICR Details

OMB Control No: 0920-0212	ICR Reference No: 202009-0920-013
Status: Historical Active	Previous ICR Reference No: 202003-0920-011
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0212-20LO
Title: National Hospital Care Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/01/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/17/2020
Terms of Clearance: Approved consistent with NCHS/CDC commitment to take public comment on the COVID-19 related questions. Prior terms continue: NCHS will continue to update OMB regularly regarding challenges with and progress toward recruiting hospitals and their ability to efficiently transfer data to NCHS, as well as its progress on developing the sampling frame for free standing ambulatory care facilities.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2022	03/31/2022	03/31/2022
Responses	7,110	0	6,512
Time Burden (Hours)	8,294	0	7,098
Cost Burden (Dollars)	0	0	0

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Abstract: This request is for a nonsubstantive change to the approved data collection for the National Hospital Care Survey (NHCS) (OMB No. 0920-0212, expiration date: 3/31/2022). The change is to allow the addition of six new survey questions related to the novel coronavirus disease (COVID-19) to the NHCS Annual Hospital Interview (AHI). These questions will be added as soon as possible to the 2020 NHCS and will continue to be included in future years of NHCS, if data collection on COVID-19 remains applicable. The questions will help provide an understanding on experiences of the provision of health care by hospitals during the ongoing COVID-19 pandemic in the United States. .

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 46488	09/13/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 455	01/29/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Annual Hospital Interview	0920-0212	Annual Hospital Interview 2019
Annual Hospital Interview (Revised)	0920	Annual Hospital Interview (revised)
Initial Hospital Intake Questionnaire	0920-0212	Initial Hospital Intake Questionnaire 2019
National Hospital Care Survey (Abstraction Form)	0920-0212	Validation of Enhanced Algorithms to Identify Opioid Use and Co-Occurring Disorders in National Hospital Care Survey (NHCS)
PCORFIT Telephone Script
Prepare and Transmit EHR for Inpatient and Ambulatory	0920-0212	EHR for Inpatient and Ambulatory (quarterly)
Prepare and transmit UB-04 or State File for Inpatient and Ambulatory	0920-0212	UB-04 or State File for Inpatient and Ambulatory (monthly)
Recruitment Survey Presentation	0920-0212	Recruitment Survey Presentation 2019

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,110	6,512	0	598	0	0
Annual Time Burden (Hours)	8,294	7,098	0	1,196	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: With the addition of the COVID-19 questions starting with the 2020 data collection, we anticipate that the change in burden would be minimal enough to be absorbed in the estimated annualized burden above. This is because the original burden estimate of two hours to complete the AHI is enough to account for the addition of these few questions. We know from previous years that the AHI does not have a 100% response rate; therefore, the original burden of 120 minutes is enough to cover minor additions.

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Annual Cost to Federal Government: $7,500,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/17/2020

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