Information Collection

Monthly Survey Patient Days & Nurse Staffing

IC 257463 under ICR 202410-0920-013 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.408 Monthly Survey Patient Days & Nurse Staffing	Form and Instruction
57.408 Monthly Survey Patient Days & Nurse Staffing 57.408 Monthly Survey Patient Days and Nurse Staffing.docx	Form and Instruction
57.408 Monthly Survey Patient Days & Nurse Staffing 57.408 Monthly Survey Patient Days and Nurse Staffing.docx	Form and Instruction

IC Title:

Monthly Survey Patient Days & Nurse Staffing

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	57.408	Monthly Survey Patient Days & Nurse Staffing	57.408 Monthly Survey Patient Days and Nurse Staffing.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

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	30,000	0	30,000
Annual IC Time Burden (Hours)	150,000	120,000	30,000
Annual IC Cost Burden (Dollars)	0	0	0

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.