National Hospital Care Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0212 Att I - Initial Intake Questionnaire	Form and Instruction	Modified	Available
Form 0920-0212 Initial Hospital Intake Questionnaire	Form and Instruction	Modified	Repair queued
Form 0920 Annual Hospital Interview (revised)	Form	Removed	Repair queued
Form 0920 Annual Hospital Interview (Revised)	Form	Removed	Repair queued
Form 0920-0212 Validation of Enhanced Algorithms to Identify Opioid Use and Co-Occurring Disorders in National Hospital Care Survey (NHCS)	Form	Removed	Available
Form 0920-0212 National Hospital Care Survey (Abstraction Form)	Form	Removed	Repair queued
Form 0920-0212 Att L - Qtr Data Trans of EHR Data	Form and Instruction	Modified	Available
Form 0920-0212 Prepare and Transmit EHR for Inpatient and Ambulatory	Form and Instruction	Modified	Repair queued
Form 0920-0212 Att C - Annual Hospital Interview	Form and Instruction	Modified	Available
Form 0920-0212 Annual Hospital Interview	Form and Instruction	Modified	Repair queued
Form 0920-0212 Att K - Monthly Data Transmission of UB-04 Data	Form and Instruction	Modified	Available
Form 0920-0212 Prepare and transmit UB-04 or State File for Inpatient and Ambulatory	Form and Instruction	Modified	Repair queued
Form 0920-0212 Att J - Recruitment Survey Presentation	Form and Instruction	Modified	Repair queued
Form 0920-0212 Recruitment Survey Presentation	Form and Instruction	Modified	Repair queued
NHCS-30day-FRN_08.27.2021.docx	Supplementary Document	Uploaded 2021-11-04	Repair queued
Att M - Proposed Confidentiality Letter.docx	Supplementary Document	Uploaded 2021-11-04	Repair queued
Att J - Recruitment Survey Presentation.docx	Supplementary Document	Uploaded 2021-11-04	Repair queued
Att H - ERB Approval Notice for NHCS.pdf	Supplementary Document	Uploaded 2021-11-04	Repair queued
Att G - EHR Variable List.xlsx	Supplementary Document	Uploaded 2021-11-04	Repair queued
Att F - Currently Approved UB04 Data Elements.docx	Supplementary Document	Uploaded 2021-11-04	Repair queued
Att E - NHCS Overview Flyer.docx	Supplementary Document	Uploaded 2021-11-04	Available
Att E - NHCS Overview Flyer.docx	Supplementary Document	Uploaded 2021-11-04	Repair queued
Att D - NHCS Introductory Letter.pdf	Supplementary Document	Uploaded 2021-11-04	Repair queued
Att A - Legislative Authority to Collect Data on Hospital Utilization.rtf	Supplementary Document	Uploaded 2021-11-04	Repair queued
0920-0212_Statement A_COVID-nonsub_09.08.2020.docx	Supplementary Document	Uploaded 2020-09-17	Repair queued
COVID-19 OMB Memo_NHCS.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-09-17	Repair queued
Nonsubstantive Change PCORTF_Opioid_04_08_2020 SK.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-04-30	Repair queued
Att M - Summary Update.docx	Supplementary Document	Uploaded 2019-01-29	Repair queued
Att K - Confidentiality Letter.docx	Supplementary Document	Uploaded 2019-01-29	Repair queued
Att G - ERB Approval Notice for NHCS.pdf	Supplementary Document	Uploaded 2019-01-29	Repair queued
Att E- EHR Variable List.pdf	Supplementary Document	Uploaded 2019-01-29	Repair queued
Att D - Currently Approved UB04 Data Elements.docx	Supplementary Document	Uploaded 2019-01-29	Repair queued
Att C - Introductory Letter to Hospitals.docx	Supplementary Document	Uploaded 2019-01-29	Repair queued
Att B2 - 60-day Federal Register Notice Comments.docx	Supplementary Document	Uploaded 2019-01-29	Repair queued
Att B1- 60-Day FRN for NHCS 120718.pdf	Supplementary Document	Uploaded 2019-01-29	Repair queued
Att A - Legislative Authority to Collect Data on Hospital Utilization.rtf	Supplementary Document	Uploaded 2019-01-29	Repair queued
0920-0212_Statement B_06.28.2021.docx	Supporting Statement B	Uploaded 2021-11-04	Repair queued
0920-0212_Statement A_07.01.2021.docx	Supporting Statement A	Uploaded 2021-11-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6666	Initial Hospital Intake Questionnaire	Form and Instruction	Modified	Att I - Initial Intake Questionnaire
6666	Initial Hospital Intake Questionnaire	Form and Instruction	Modified
243666	Annual Hospital Interview (Revised)	Form	Removed	Annual Hospital Interview (revised)
243666	Annual Hospital Interview (Revised)	Form	Removed
241648	PCORFIT Telephone Script	Other-WORD	Removed
240789	National Hospital Care Survey (Abstraction Form)	Form	Removed	Validation of Enhanced Algorithms to Identify Opioid Use and Co-Occurring Disorders in National Hospital Care Survey (NHCS)
240789	National Hospital Care Survey (Abstraction Form)	Form	Removed
186285	Prepare and Transmit EHR for Inpatient and Ambulatory	Form and Instruction	Modified	Att L - Qtr Data Trans of EHR Data
186285	Prepare and Transmit EHR for Inpatient and Ambulatory	Form and Instruction	Modified
186283	Annual Hospital Interview	Form and Instruction	Modified	Att C - Annual Hospital Interview
186283	Annual Hospital Interview	Form and Instruction	Modified
186282	Prepare and transmit UB-04 or State File for Inpatient and Ambulatory	Form and Instruction	Modified	Att K - Monthly Data Transmission of UB-04 Data
186282	Prepare and transmit UB-04 or State File for Inpatient and Ambulatory	Form and Instruction	Modified
186281	Recruitment Survey Presentation	Form and Instruction	Modified	Att J - Recruitment Survey Presentation
186281	Recruitment Survey Presentation	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0212	ICR Reference No: 202110-0920-008
Status: Historical Active	Previous ICR Reference No: 202009-0920-013
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0212
Title: National Hospital Care Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/22/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/04/2021
Terms of Clearance: Approved consistent with NCHS/CDC commitment to 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	12/31/2024	36 Months From Approved	03/31/2022
Responses	6,604	0	7,110
Time Burden (Hours)	7,184	0	8,294
Cost Burden (Dollars)	0	0	0

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Abstract: The National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), requests a three-year approval for a revision to continue the National Hospital Care Survey (NHCS) (OMB No. 0920-0212, expires 03/31/2022). There are no changes to the data collection survey.

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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:
	86 FR 38094	07/19/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 57835	10/19/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Annual Hospital Interview	0920-0212	Att C - Annual Hospital Interview
Annual Hospital Interview (Revised)	0920	Annual Hospital Interview (revised)
Initial Hospital Intake Questionnaire	0920-0212	Att I - Initial Intake Questionnaire
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	Att L - Qtr Data Trans of EHR Data
Prepare and transmit UB-04 or State File for Inpatient and Ambulatory	0920-0212	Att K - Monthly Data Transmission of UB-04 Data
Recruitment Survey Presentation	0920-0212	Att J - Recruitment Survey Presentation

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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	6,604	7,110	0	122	-628	0
Annual Time Burden (Hours)	7,184	8,294	0	104	-1,214	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The proposed burden for the NHCS is 7,184 hours per data collection year. Because additional sample hospitals have been recruited for NHCS since the last approval request, fewer hospitals still need the initial two steps of recruitment.

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Annual Cost to Federal Government: $8,700,000

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: 11/04/2021

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