Information Collection

[NCEZID] Hospital System Approach to Collecting Race, Ethnicity, and Language Data

IC 267631 under ICR 202507-0920-010 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 092061154 NHSN’s REaLI Effort [NCEZID] Hospital System Approach to Collecting Race, Ethnicity, and Language Data	Form
092061154 NHSN’s REaLI Effort Attachment 1_SDOH Redcap Survey - Final V4.1.docx	Form
REaL Data_GenIC Requestv2.docx Request for genIC Approval (24FT)	IC Document
REaL Data_Supporting Statement A (0920-1154)_v3.docx SSA (24FT)	IC Document
REaL Data_Supporting Statement B (0920-1154).docx SSB (24FT)	IC Document
Attachment 2_IRB Determination.pdf IRB Determination (24FT)	IC Document
Attachment 3_CoLab REaLI final letter_v2.docx CoLab REaLI_Partner's final letter (24FT)	IC Document
Attachment 4_CoLab reminder 2 w email final.docx CoLab REaLI_2nd reminder w/email (24FT)	IC Document
Attachment 5_CoLAB reminder final email.docx CoLab REaLI_final reminder email (24FT)	IC Document

IC Title:

[NCEZID] Hospital System Approach to Collecting Race, Ethnicity, and Language Data

Agency IC Tracking Number:

0920-1154-24FT

IC Status: Unchanged

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	092061154				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for genIC Approval (24FT)		05/28/2024
SSA (24FT)		05/28/2024
SSB (24FT)		05/15/2024
IRB Determination (24FT)		05/15/2024
CoLab REaLI_Partner's final letter (24FT)		05/28/2024
CoLab REaLI_2nd reminder w/email (24FT)		05/15/2024
CoLab REaLI_final reminder email (24FT)		05/15/2024

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

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