Information Collection

Reinterview Study 2021

IC 233076 under ICR 202201-0920-017 · OMB 0920-0278.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Reinterview Study 2021	Form and Instruction
Reinterview Study 2021 Reinterview Study 2021	Form and Instruction
Reinterview Study 2021 Attachment L2 - Reinterview Study Questionnaire (2021).pdf	Form and Instruction
Reinterview Study 2021 Attachment L2 - Reinterview Study Questionnaire (2021).pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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 and Instruction	none				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: 125

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	125	125
Annual IC Time Burden (Hours)	31	31
Annual IC Cost Burden (Dollars)	3,668	3,668

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.

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