Information Collection

Pre-Hospital Care Data - PCNASP Awardee -EMS respondents

IC 236180 under ICR 202408-0920-015 · OMB 0920-1108.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 4a_Pre hospital data elements_Clean.docx	Other-Data elements
Attachment 4a_Pre hospital data elements_Clean.docx	Other-Data elements

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
Other-Data elements					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	40	0	40
Annual IC Time Burden (Hours)	40	0	40
Annual IC Cost Burden (Dollars)	0	-2,932	2,932

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.

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