Ambulatory Unit Induction Interview 2022

National Hospital Ambulatory Medical Care Survey

Documents and Forms

Document Name Document Type
Form 0920-22BT Ambulatory Unit Induction Interview 2022 Form and Instruction
0920-22BT Attachment E - Ambulatory Unit Induction Questionnaire ( Attachment E - Ambulatory Unit Induction Questionnaire (2022).docx Form and Instruction
0920-22BT Attachment E - Ambulatory Unit Induction Questionnaire ( Attachment E - Ambulatory Unit Induction Questionnaire (2022).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Ambulatory Unit Induction Interview 2022	Agency IC Tracking Number:	0920-22BT

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	0920-22BT	Attachment E - Ambulatory Unit Induction Questionnaire (2022)	Attachment E - Ambulatory Unit Induction Questionnaire (2022).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health Resources Utilization Statistics	FR Citation: 49 FR 37693

Number of Respondents: 820	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	820	820
Annual IC Time Burden (Hours)	205	205
Annual IC Cost Burden (Dollars)	12,070	12,070

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.