View Information Collection Request (ICR) Package
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View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0212
ICR Reference No:
200909-0920-005
Status:
Historical Active
Previous ICR Reference No:
200808-0920-008
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
National Hospital Discharge Survey
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
09/18/2009
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/14/2009
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
10/31/2011
10/31/2011
10/31/2011
Responses
33,755
0
33,755
Time Burden (Hours)
5,591
0
5,591
Cost Burden (Dollars)
0
0
0
Abstract:
This request is for permission to collect data for the current National Hospital Discharge Survey in 2010. The currently approved plan was to end in 2009, with a redesigned survey beginning in 2010. Budget constraints make it necessary to keep the current survey in the field through 2010 until the redesigned survey can be integrated in 2011. There is no change in burden.
Authorizing Statute(s):
US Code:
42 USC 242k
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
15
IC Title
Form No.
Form Name
MHDS - 2010 & 2011 Survey Presentation to Hospitals
NHDS - 2010 & 2011 Facility Questionnaire
NHDS - 2010 & 2011 Sample listing sheet
NHDS - 2010 & 2011 Verify Sampling and Reabstract
NHDS - Alternate Procedure Hospitals Locating Medical Records Manual
NHDS - Hospital In-house Tape or Printout Transmittal Notice
NHDS - Hospital Interview Questionnaire
NHDS - Medical abstract form
NHDS - Pretest Debrief Hospital Staff Guide
NHDS - Pretest Facility Questionnaire
NHDS - Pretest Sample Listing Sheet
NHDS - Pretest Survey Presentation
NHDS - Pretest Verify Sampling and Reabstract
NHDS - Primary Procedure Hospitals Sample Listing Sheet
NHDS - Primary Procedures Hospital Transmittal Notice
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
33,755
33,755
0
0
0
0
Annual Time Burden (Hours)
5,591
5,591
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$4,461,112
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Maryam Daneshvar 4046394604
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
09/14/2009
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