Information Collection

Ambulatory Unit Induction Interview 2022

IC 241281 under ICR 202201-0920-017 · OMB 0920-0278.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

0920-22BT

Is this a Common Form? No

IC Status: Modified

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	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 %

table that charts list of burden
	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

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.