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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Hospital-Based Victim Services Frame Development Project
Agency IC Tracking Number:
0920-1030-19ALS
IC Status:
New
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
Form and Instruction
0920-1030
Telephone Script
Attachment B - NSHVS Telephone Script 040319.docx
No
Fillable Fileable
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:
4,800
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
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
4,800
0
4,800
0
0
0
Annual IC Time Burden (Hours)
1,200
0
1,200
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA
NSHVS Project - GenIC Statement A 040319 ICRO.doc
04/17/2019
Cognitive Testing Report
Attachment A - NSHVS Cognitive Testing Final Report 12202018 (OMB).pdf
04/17/2019
Follow-up Non-response Letter
Attachment C - NSHVS Follow-up non-responsive letter 040319 ICRO.docx
04/17/2019
Expert Panel List
Attachment D - List of expert panel meeting attendees 12202018 (OMB).docx
04/17/2019
HS Determination
Attachment E - Signed Human Subjects Determination Form.pdf
04/17/2019
Part B
NSHVS Project Supporting Statement B 072919 Rev.doc
08/05/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.