Information Collection

Attachment B: Child HCAHPS Database Data Use Agreement

IC 235457 under ICR 202601-0935-001 · OMB 0935-0243.

Documents and Forms

Document Name Document Type
Form 2 Attachment B: Child HCAHPS Database Data Use Agreement Form and Instruction
Form 2 Attachment B- Child CAHPS Database DUA Attachment B: Child HCAHPS Database Data Use Agreement Form and Instruction
2 Attachment B- Child CAHPS Database DUA Attachment B CAHPS Child Hospital Survey Database Data Use Agreement.pdf Form and Instruction
2 Attachment B- Child CAHPS Database DUA Attachment B CAHPS Child Hospital Survey Database Data Use Agreement.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Attachment B: Child HCAHPS Database Data Use Agreement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	Attachment B- Child CAHPS Database DUA	Attachment B CAHPS Child Hospital Survey Database Data Use Agreement.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	50	0	-250	300
Annual IC Time Burden (Hours)	3	0	-12	15
Annual IC Cost Burden (Dollars)	758	228	530	0

Documents for IC

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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