National Hospital Care Survey

Forms and Documents

Document Name	Status
Form 0920-0212 Initial Hospital Intake Questionnaire Form and Instruction	Unchanged
Form 0920-0212 National Hospital Care Survey (Abstraction Form) Form	New
Form 0920-0212 Prepare and Transmit EHR for Inpatient and Ambulatory Form and Instruction	Unchanged
Form 0920-0212 Annual Hospital Interview Form and Instruction	Unchanged
Form 0920-0212 Prepare and transmit UB-04 or State File for Inpatient and Ambulatory Form and Instruction	Unchanged
Form 0920-0212 Recruitment Survey Presentation Form and Instruction	Unchanged
Nonsubstantive Change PCORTF_Opioid_04_08_2020 SK.docx Justification for No Material/Nonsubstantive Change	2020-04-30
Att M - Summary Update.docx Supplementary Document	2019-01-29
Att K - Confidentiality Letter.docx Supplementary Document	2019-01-29
Att G - ERB Approval Notice for NHCS.pdf Supplementary Document	2019-01-29
Att E- EHR Variable List.pdf Supplementary Document	2019-01-29
Att D - Currently Approved UB04 Data Elements.docx Supplementary Document	2019-01-29
Att C - Introductory Letter to Hospitals.docx Supplementary Document	2019-01-29
Att B2 - 60-day Federal Register Notice Comments.docx Supplementary Document	2019-01-29
Att B1- 60-Day FRN for NHCS 120718.pdf Supplementary Document	2019-01-29
Att A - Legislative Authority to Collect Data on Hospital Utilization.rtf Supplementary Document	2019-01-29
0920-0212_Statement B_02.27.2019.docx Supporting Statement B	2019-03-05
0920-0212_Statement A_02.27.2019.docx Supporting Statement A	2019-03-05

IC Document Collections

IC ID	Document Title	Status
6666	Initial Hospital Intake Questionnaire Form and Instruction	Unchanged
241648	PCORFIT Telephone Script Other-WORD	New
240789	National Hospital Care Survey (Abstraction Form) Form	New
186285	Prepare and Transmit EHR for Inpatient and Ambulatory Form and Instruction	Unchanged
186283	Annual Hospital Interview Form and Instruction	Unchanged
186282	Prepare and transmit UB-04 or State File for Inpatient and Ambulatory Form and Instruction	Unchanged
186281	Recruitment Survey Presentation Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0212	ICR Reference No: 202003-0920-011
Status: Historical Active	Previous ICR Reference No: 201901-0920-008
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0212-20LO
Title: National Hospital Care 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: 07/30/2020
	Date Received in OIRA: 04/30/2020
Terms of Clearance: Prior terms continue: NCHS will continue to update OMB regularly regarding challenges with and progress toward recruiting hospitals and their ability to efficiently transfer data to NCHS, as well as its progress on developing the sampling frame for free standing ambulatory care facilities.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2022	03/31/2022	03/31/2022
Responses	6,512	0	6,482
Time Burden (Hours)	7,098	0	7,080
Cost Burden (Dollars)	0	0	0

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Abstract: This request is for a nonsubstantive change to an approved data collection (OMB No. 0920-0212, Exp. Date 03/31/2022). On March 5, 2019, the National Center for Health Statistics (NCHS) was approved for the National Hospital Care Survey (NHCS) to collect data for 3 years – 2020, 2021, and 2022 – from emergency department, inpatient, and outpatient settings. In fiscal year 2018 (FY18), NCHS was awarded funding through the Patient Centered Outcomes Research Trust Fund (PCORTF) for a project to develop enhanced methods that make use of all available structured and unstructured data in the electronic health record (EHR) to identify opioid use in linked hospital and mortality data. In fiscal year 2019 (FY19), NCHS was awarded additional PCORTF funding for a capstone project to modify these methods to build a new set of algorithms to identify co-occurring disorders among opioid users.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 46488	09/13/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 455	01/29/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
PCORFIT Telephone Script
Initial Hospital Intake Questionnaire	0920-0212	Initial Hospital Intake Questionnaire 2019
Recruitment Survey Presentation	0920-0212	Recruitment Survey Presentation 2019
Prepare and transmit UB-04 or State File for Inpatient and Ambulatory	0920-0212	UB-04 or State File for Inpatient and Ambulatory (monthly)
Annual Hospital Interview	0920-0212	Annual Hospital Interview 2019
Prepare and Transmit EHR for Inpatient and Ambulatory	0920-0212	EHR for Inpatient and Ambulatory (quarterly)
National Hospital Care Survey (Abstraction Form)	0920-0212	Validation of Enhanced Algorithms to Identify Opioid Use and Co-Occurring Disorders in National Hospital Care Survey (NHCS)

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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	6,512	6,482	0	30	0	0
Annual Time Burden (Hours)	7,098	7,080	0	18	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: One of the objectives of the PCORTF work is to conduct a validation study to assess the performance of opioid use algorithms developed in the FY18 project and co-occurring disorder algorithms developed in the FY19 project. Findings from this study will be used to identify the highest performing iterations of both sets of algorithms.

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Annual Cost to Federal Government: $7,500,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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: 04/30/2020

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