Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual Hospital Interview Unchanged 598 1196 0 Form and Instruction 0920-0212 Annual Hospital Interview 2019
Annual Hospital Interview (Revised) New 598 1196 0 Form 0920 Annual Hospital Interview (revised)
Initial Hospital Intake Questionnaire Unchanged 150 150 0 Form and Instruction 0920-0212 Initial Hospital Intake Questionnaire 2019
National Hospital Care Survey (Abstraction Form) Unchanged 5 5 0 Form 0920-0212 Validation of Enhanced Algorithms to Identify Opioid Use and Co-Occurring Disorders in National Hospital Care Survey (NHCS)
PCORFIT Telephone Script Unchanged 25 13 0 Other-WORD
Prepare and Transmit EHR for Inpatient and Ambulatory Unchanged 796 796 0 Form and Instruction 0920-0212 EHR for Inpatient and Ambulatory (quarterly)
Prepare and transmit UB-04 or State File for Inpatient and Ambulatory Unchanged 4788 4788 0 Form and Instruction 0920-0212 UB-04 or State File for Inpatient and Ambulatory (monthly)
Recruitment Survey Presentation Unchanged 150 150 0 Form and Instruction 0920-0212 Recruitment Survey Presentation 2019
Total burden requested under this ICR: 7110 8294 0  
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