Information Collection

Community-Based Organization Report - NHME

IC 217851 under ICR 202410-0920-022 · OMB 0920-0696.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0696 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 5A NHME Variables July 2018.pdf	Other-Data Elements
Att 5A NHME Variables July 2018.pdf	Other-Data Elements
Att 5A NHME Variables.pdf	Other-Data Reporting
Att 5A NHME Variables.pdf	Other-Data Reporting
Att 5A NHME Variables.pdf	Other-Data Reporting
Att 5A NHME Variables.pdf	Other-Data Reporting
Att 5B NHME Variables Options July 2018.docx Data Variable Options	IC Document
Att 5B NHME Variables Options July 2018.docx Data Variable Options	IC Document

IC Title:

Community-Based Organization Report - NHME

Agency IC Tracking Number:

0920-0696

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Elements	Att 5A NHME Variables July 2018.pdf	Yes	Yes	Fillable Printable
Other-Data Reporting	Att 5A NHME Variables.pdf	Yes	Yes	Fillable Fileable
Other-Data Reporting	Att 5A NHME Variables.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: 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	300	0	300
Annual IC Time Burden (Hours)	16,200	0	16,200
Annual IC Cost Burden (Dollars)	0	-313,632	313,632

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Data Variable Options	Att 5B NHME Variables Options July 2018.docx	08/20/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.