Information Collection

Hospital Induction Interview 2018

IC 214297 under ICR 201809-0920-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Hospital Induction Interview 2018 Form and Instruction
Hospital Induction Interview Attachment H - Hospital Induction Interview 060118.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Hospital Induction Interview 2018	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 and Instruction	none	Hospital Induction Interview	Attachment H - Hospital Induction Interview 060118.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health Resources Utilization Statistics (09-20-0167)	FR Citation: 49 FR 37693

Number of Respondents: 113	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	113	-227	340
Annual IC Time Burden (Hours)	85	-170	255
Annual IC Cost Burden (Dollars)	7,919	-15,908	23,827

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.