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Federal forms, ICRs, and supporting documents

Information Collection

57.102 - Hospital Respiratory Data Form (Daily - user entry)

IC 269866 under ICR 202602-0920-005 · OMB 0920-1317.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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57.102 - Hospital Respiratory Data Form (Daily - user entry)
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024 57.102 Hospital Respiratory Data Form - Daily Reporting - Clean Version.docx N/A Yes Yes Fillable Fileable

Health Public Health Monitoring

 

492 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 179,580 0 0 0 0 179,580
Annual IC Time Burden (Hours) 173,594 0 0 0 0 173,594
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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