Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Abstraction and Reabstraction for the ACS module of the NHDS Modified 33 8 0 Other-Word
MHDS - 2010 & 2011 Survey Presentation to Hospitals Removed 0 0 0 Other-2010 & 2011 Survey Presentation to Hospitals
NHDS - 2010 & 2011 Facility Questionnaire Removed 0 0 0 Other-Facility Questionnaire
NHDS - 2010 & 2011 Sample listing sheet Removed 0 0 0 Other-2010 & 2011 Sample listing sheet
NHDS - 2010 & 2011 Verify Sampling and Reabstract Removed 0 0 0 Other-2010 & 2011 Verify Sample and Reabstraction
NHDS - Pretest Debrief Hospital Staff Guide Removed 0 0 0 Other-Pretest Debrief Hospital Staff Guide
NHDS - Pretest Facility Questionnaire Removed 0 0 0 Other-Pretest Facililty Questionnaire
NHDS - Pretest Sample Listing Sheet Removed 0 0 0 Other-Pretest Sample Listing Sheet
NHDS - Pretest Survey Presentation Removed 0 0 0 Other-Survey Presentation for Pretest
NHDS - Pretest Verify Sampling and Reabstract Removed 0 0 0 Other-Pretest Verify Sampling and Reabstract
NHDS Facility Questionaire Part A - D Modified 167 668 0 Other-WORD
NHDS Survey Presentation Modified 167 167 0 Other-Word
NHDS Survey Presentation for the ACS (Interview w/Hospital Executive and Staff) Modified 11 11 0 Other-Word
Post Induction - Facility Questionnaire (Part D) Modified 333 666 0 Other-WORD
Quarterly Transmission of UB -04 Data Modified 2000 2000 0 Other-WORD
Total burden requested under this ICR: 2711 3520 0  
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