Hospital Induction Interview 2020

National Hospital Ambulatory Medical Care Survey

Documents and Forms

Document Name Document Type
Hospital Induction Interview 2020 Form and Instruction
Hospital induction questionnaire 2020 Attachment C1 - Induction questionnaire (2020) 04.09.2020.docx Form and Instruction
Hospital induction questionnaire 2020 Attachment C1 - Induction questionnaire (2020) 04.09.2020.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Hospital Induction Interview 2020	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	none	Hospital induction questionnaire 2020	Attachment C1 - Induction questionnaire (2020) 04.09.2020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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

Number of Respondents: 137	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	Previously Approved
Annual Number of Responses for this IC	137	137
Annual IC Time Burden (Hours)	69	69
Annual IC Cost Burden (Dollars)	8,041	8,041

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.