Information Collection

ADSC Services User Questionnaire

IC 253598 under ICR 202407-0920-006 · OMB 0920-0943.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0943 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ADSC Services User Questionnaire	Form and Instruction
ADSC Services User Questionnaire Items Att C-4 ADSC SU questionnaire.docx	Form and Instruction
ADSC Services User Questionnaire Items Att C-4 ADSC SU questionnaire.docx	Form and Instruction

IC Title:

ADSC Services User Questionnaire

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	ADSC Services User Questionnaire Items	Att C-4 ADSC SU questionnaire.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 37697

Number of Respondents: 875

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-875	875
Annual IC Time Burden (Hours)	-438	438
Annual IC Cost Burden (Dollars)	-24,990	24,990

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.