View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

CDC mPINC Hospital Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-0743 Yes Yes Fillable Fileable

Health Public Health Monitoring

 

1,293 0
   
Individuals or Households
 
   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 1,293 0 -128 0 0 1,421
Annual IC Time Burden (Hours) 647 0 -64 0 0 711
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Att 3d Screenshots mPINC 2022 09/29/2021
Att 5a Sirveu Cover Letter (paper) 09/29/2021
Att 5b Survey Cover Letter (email) 09/29/2021
Att 5e_Reminder (email) 09/29/2021
OMB Bulletin No. 00-22 03/15/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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