Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
MHDS - 2010 & 2011 Survey Presentation to Hospitals New 80 80 0 Other-2010 & 2011 Survey Presentation to Hospitals
NHDS - 2010 & 2011 Facility Questionnaire New 80 320 0 Other-Facility Questionnaire
NHDS - 2010 & 2011 Sample listing sheet New 19200 4480 0 Other-2010 & 2011 Sample listing sheet
NHDS - 2010 & 2011 Verify Sampling and Reabstract New 75 18 0 Other-2010 & 2011 Verify Sample and Reabstraction
NHDS - Alternate Procedure Hospitals Locating Medical Records Manual New 10250 171 0 Other-Attachment G4 - Hospital Manual
NHDS - Hospital In-house Tape or Printout Transmittal Notice New 348 75 0 Other-Attachment G5 - Hospital In-house Tape or Printout Transmittal Notice
NHDS - Hospital Interview Questionnaire New 10 20 0 Other-Hospital Interview Questionnaire
NHDS - Medical abstract form Modified 3250 271 0 Other-Medical Abstract Form
NHDS - Pretest Debrief Hospital Staff Guide New 10 10 0 Other-Pretest Debrief Hospital Staff Guide
NHDS - Pretest Facility Questionnaire New 10 40 0 Other-Pretest Facililty Questionnaire
NHDS - Pretest Sample Listing Sheet New 100 23 0 Other-Pretest Sample Listing Sheet
NHDS - Pretest Survey Presentation New 10 10 0 Other-Survey Presentation for Pretest
NHDS - Pretest Verify Sampling and Reabstract New 20 5 0 Other-Pretest Verify Sampling and Reabstract
NHDS - Primary Procedure Hospitals Sample Listing Sheet New 156 65 0 Other-Primary Procedures Hospitals Sampling Listing Sheet
NHDS - Primary Procedures Hospital Transmittal Notice New 156 3 0 Other-Primary Procedures Hospitals Transmittal Notice
Total burden requested under this ICR: 33755 5591 0  
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