Information Collection

Annual Hospital Interview (Revised)

IC 243666 under ICR 202110-0920-008 · OMB 0920-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0212 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920 Annual Hospital Interview (Revised)	Form
0920 Annual Hospital Interview (revised) Att A - 2020 Annual Hospital Interview (Revised).docx	Form
0920 Annual Hospital Interview (revised) Att A - 2020 Annual Hospital Interview (Revised).docx	Form

IC Title:

Annual Hospital Interview (Revised)

Agency IC Tracking Number:

0920-0212-20RX

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	0920	Annual Hospital Interview (revised)	Att A - 2020 Annual Hospital Interview (Revised).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 598

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-598	598
Annual IC Time Burden (Hours)	-1,196	1,196
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.