Information Collection

NHDS - Pretest Sample Listing Sheet

IC 186288 under ICR 200808-0920-008 · OMB 0920-0212.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0212 can be found here:

Documents and Forms

Document Name Document Type
Attachment J Pretest Sampling listing sheet redesign.doc Other-Pretest Sample Listing Sheet
Attachment L PATIENT ABSTRACT June 25 08.doc Attachment L - Pretest Patient Abstraction Form IC Document
Attachment L cover with burden.doc Cover sheet for abstraction form IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NHDS - Pretest Sample Listing Sheet	Agency IC Tracking Number:

Is this a Common Form? Yes		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
Other-Pretest Sample Listing Sheet			Attachment J Pretest Sampling listing sheet redesign.doc		No	No	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: 10	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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment L - Pretest Patient Abstraction Form	Attachment L PATIENT ABSTRACT June 25 08.doc	07/24/2008
Cover sheet for abstraction form	Attachment L cover with burden.doc	07/24/2008

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