Information Collection Request

National Hospital Care Survey

ICR 202407-0920-002 · OMB 0920-0212 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-0212 NHCS Initial Hospital Intake Questionnaire Form and Instruction Modified Available
Form 0920-0212 Att P_Initial Hospital Intake Questionnaire Form and Instruction Modified Repair queued
Form 0920-0212 Quarterly Transmission of EHR Data Form and Instruction Modified Available
Form 0920-0212 Att S_Quarterly Transmission of EHR Data Form and Instruction Modified Repair queued
Form 0920-0212 20XX Annual Hospital Interview (AHI) Form and Instruction Modified Available
Form 0920-0212 Att C_Annual Hospital Interview Form and Instruction Modified Repair queued
Form 0920-0212 Monthly Data Transmission of UB-04 Data Form and Instruction Modified Available
Form 0920-0212 Att R_Monthly Transmission of UB-04 Data Form and Instruction Modified Repair queued
Form 0920-0212 National Hospital Care Survey Presentation For Hospital Executive and Staff Form and Instruction Modified Available
Form 0920-0212 Att Q_Recruitment Survey Presentation Form and Instruction Modified Repair queued
Att E - NHCS Overview Flyer.pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att W - SORN Privacy Act System Notice 09-20-0164.pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att V - SORN Privacy Act System Notice 09-20-0167.pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att U - ERB Memo - Protocol Determination Verification Status for NHCS.pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att T - NHCS Confidentiality Letter.docx Supplementary Document Uploaded 2024-07-26 Repair queued
Att O - ERB Approval Notice for NHCS.pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att L - NHCS Infographic Flyer (Southwest).pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att K - NHCS Infographic Flyer (West).pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att J - NHCS Infographic Flyer (East).pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att I - NHCS Infographic Flyer (South).pdf Supplementary Document Uploaded 2024-07-26 Available
Att H - NHCS Infographic Flyer (Rural).pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att G - NHCS Infographic Flyer (Childrens).pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att F - NHCS Infographic Flyer (General).pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att D - NHCS Introductory Letter.pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att N - EHR Variable List.xlsx Supplementary Document Uploaded 2024-07-26 Available
Att M - Currently Approved UB04 Data Elements.docx Supplementary Document Uploaded 2024-07-26 Repair queued
Att D - NHCS Introductory Letter.pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att B - Published 60-Day FRN NHCS 5.7.24.pdf Supplementary Document Uploaded 2024-07-26 Repair queued
Att A - Legislative Authority to Collect Data on Hospital Utilization.rtf Supplementary Document Uploaded 2024-07-26 Repair queued
0920-0212 Statement B 07.09.24.docx Supporting Statement B Uploaded 2024-07-26 Repair queued
0920-0212 Statement A 07.26.24.docx Supporting Statement A Uploaded 2024-07-26 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
6666 Att P_Initial Hospital Intake Questionnaire Form and Instruction ModifiedNHCS Initial Hospital Intake Questionnaire
6666 Att P_Initial Hospital Intake Questionnaire Form and Instruction Modified
186285 Att S_Quarterly Transmission of EHR Data Form and Instruction ModifiedQuarterly Transmission of EHR Data
186285 Att S_Quarterly Transmission of EHR Data Form and Instruction Modified
186283 Att C_Annual Hospital Interview Form and Instruction Modified20XX Annual Hospital Interview (AHI)
186283 Att C_Annual Hospital Interview Form and Instruction Modified
186282 Att R_Monthly Transmission of UB-04 Data Form and Instruction ModifiedMonthly Data Transmission of UB-04 Data
186282 Att R_Monthly Transmission of UB-04 Data Form and Instruction Modified
186281 Att Q_Recruitment Survey Presentation Form and Instruction ModifiedNational Hospital Care Survey Presentation For Hospital Executive and Staff
186281 Att Q_Recruitment Survey Presentation Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2027 36 Months From Approved 12/31/2024
5,826 0 6,604
5,826 0 7,184
0 0 0





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
Att C_Annual Hospital Interview 0920-0212
Att P_Initial Hospital Intake Questionnaire 0920-0212
Att Q_Recruitment Survey Presentation 0920-0212
Att R_Monthly Transmission of UB-04 Data 0920-0212
Att S_Quarterly Transmission of EHR Data 0920-0212

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,826 6,604 0 -778 0 0
Annual Time Burden (Hours) 5,826 7,184 0 -1,358 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No