Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Att C_Annual Hospital Interview Modified 601 601 0 Form and Instruction 0920-0212 20XX Annual Hospital Interview (AHI)
Att P_Initial Hospital Intake Questionnaire Modified 123 123 0 Form and Instruction 0920-0212 NHCS Initial Hospital Intake Questionnaire
Att Q_Recruitment Survey Presentation Modified 30 30 0 Form and Instruction 0920-0212 National Hospital Care Survey Presentation For Hospital Executive and Staff
Att R_Monthly Transmission of UB-04 Data Modified 4272 4272 0 Form and Instruction 0920-0212 Monthly Data Transmission of UB-04 Data
Att S_Quarterly Transmission of EHR Data Modified 800 800 0 Form and Instruction 0920-0212 Quarterly Transmission of EHR Data
Total burden requested under this ICR: 5826 5826 0  
To view an IC, click on IC Title