OMB control number

Ambulatory Care Pretest: National Hospital Care Survey

OMB 0920-0944 · HHS/CDC.

OMB 0920-0944

Latest forms, documents, and information collections
Document	Type
Form 5 Pulling and Refiling Medical Records	Form
Form 4 Prepare and Transmit UB-04 Files	Form
Form 3 Ambulatory Induction	Form
Form 2 Free-Standing Ambulatory Surgery Center Induction	Form
Form 1 Hospital Induction Interview	Form
Sup Sta Part B FINAL 050312.docx	Supporting Statement B
Att L AS PRF.docx	Supplementary Document
Att K OPD PRF.docx	Supplementary Document
Att J - NHCS Ambulatory Pretest ED PRF.xlsx	Supplementary Document
Att F Flowchart.docx	Supplementary Document
Att E FSASC Intro Letter.docx	Supplementary Document
Att D Hospital Intro Letter.docx	Supplementary Document
Att C - NHCS Ambulatory Pretest IRB Approval Letter.pdf	Supplementary Document
Att A Applicable Laws and Regulations.docx	Supplementary Document
NHCS Amb Pretest Sup Sta Part A FINAL Rev. 073012.docx	Supporting Statement A
Pulling and Refiling Medical Records	Form
Prepare and Transmit UB-04 Files	Form
Ambulatory Induction	Form
Free-Standing Ambulatory Surgery Center Induction	Form
Hospital Induction Interview	Form

Historical document collections
Reference	Filing	Received	Concluded	Action
201205-0920-009	New collection (Request for a new OMB Control Number)	2012-05-23		Approved without change