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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.