Information Collection

Ambulatory Unit Record

IC 43613 under ICR 201011-0920-002 · OMB 0920-0278.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0278 can be found here:

Documents and Forms

Document Name Document Type
Form unnumbered Ambulatory Unit Record Form
unnumbered Att. J. Ambulatory Unit Induction Form NHAMCS2010 Attachment J - NHAMCS-101U.pdf Form
Att. J. Ambulatory Unit Induction Form - 11/29/2010 nhamcs101u.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ambulatory Unit Record	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	unnumbered	Att. J. Ambulatory Unit Induction Form	NHAMCS2010 Attachment J - NHAMCS-101U.pdf		Yes	Yes	Paper Only
Form	none	Att. J. Ambulatory Unit Induction Form - 11/29/2010	nhamcs101u.pdf		Yes	Yes	Paper Only

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: 1,779	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,779	1,779
Annual IC Time Burden (Hours)	1,779	1,779
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.