Information Collection

Hospital Leader - Follow-Up Survey

IC 261471 under ICR 202404-0920-001 · OMB 0920-1415.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Hospital Leader - Follow-Up Survey	Form and Instruction
Hospital Leader - Follow-Up Survey 5 Hospital leader follow-up survey.docx	Form and Instruction
Hospital Leader - Follow-Up Survey 5 Hospital leader follow-up survey.docx	Form and Instruction
0920-1415 Hospital Leader - Follow-Up Survey 5 Hospital leader follow-up survey_proposed_clean.docx	Form and Instruction
0920-1415 Hospital Leader - Follow-Up Survey 5 Hospital leader follow-up survey_proposed_clean.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

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	NA	Hospital Leader - Follow-Up Survey	5 Hospital leader follow-up survey.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-1415	Hospital Leader - Follow-Up Survey	5 Hospital leader follow-up survey_proposed_clean.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	1,073	1,073

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.