Annual Hospital Interview

National Hospital Care Survey

Documents and Forms

Document Name Document Type
Form 0920-0212 Annual Hospital Interview Form and Instruction
0920-0212 Att C - Annual Hospital Interview Att C - Annual Hospital Interview v2.docx Form and Instruction
0920-0212 Att C - Annual Hospital Interview Att C - Annual Hospital Interview v2.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Annual Hospital Interview	Agency IC Tracking Number:	0920-0212

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0212	Att C - Annual Hospital Interview	Att C - Annual Hospital Interview v2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0167 Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 608	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	608	10	598
Annual IC Time Burden (Hours)	1,216	20	1,196
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.