View Information Collection (IC)

View Information Collection (IC)

IC Title:	NHDS - Pretest Sample Listing Sheet	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Pretest Sample Listing Sheet			Attachment J Pretest Sampling listing sheet redesign.doc		No	No	Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health Resources Utilization Statistics	FR Citation: 49 FR 37697

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	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	0	0	-100	0	0	100
Annual IC Time Burden (Hours)	0	0	-23	0	0	23
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment L - Pretest Patient Abstraction Form	Attachment L PATIENT ABSTRACT June 25 08.doc	07/24/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.