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Formative Research to Identify Common and Unique Barriers to the Exchange of Hospitalization and ED Data 0920-1154-19BEA
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Survey AttA2_Survey instrument (screenshots).pdf Yes Yes Fillable Fileable
Form none Survey - word AttA1_Survey Instrument (word).docx Yes Yes Fillable Fileable
Form none Survey prenotice AttB1_Prenotice.DOCX Yes Yes Fillable Fileable

Health Public Health Monitoring

 

52 0
   
State, Local, and Tribal Governments
 
   100 %

  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 52 0 52 0 0 0
Annual IC Time Burden (Hours) 113 0 113 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
genIC Request GenICRequest.pdf 07/29/2019
Survey Invitation AttB2_Survey Invitation Email.DOCX 07/29/2019
Reminder Email AttB3_Reminder Email.docx 07/29/2019
Survey Closing Email AttB4_Survey Closing Email.DOCX 07/29/2019
Research Determination AttC_RDF.pdf 07/29/2019
Supporting Statement A SSA_Formative Research to Identify Common and ED Data.docx 07/29/2019
Supporting Statement B SSB_Formative Research to Identify Common and ED Data.docx 07/29/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.