Information Collection Request

National Hospital Care Survey

ICR 201502-0920-011 · OMB 0920-0212 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
Initial Hospital Intake Questionnaire Form Modified Available
Annual FSASC Interview Form Removed Available
Ambulatory Unit Induction Form Removed Available
0920-0212 SS A 013015.docx Supporting Statement A Uploaded 2015-02-19 Repair queued
Att V - OPD PRF Changes.docx Supplementary Document Uploaded 2015-02-18 Available
Att U - ED PRF Changes.docx Supplementary Document Uploaded 2015-02-18 Available
Att T - Hosp Amb Interview Changes.docx Supplementary Document Uploaded 2015-02-18 Repair queued
Att S - NHCS FAQ Brochure.pdf Supplementary Document Uploaded 2015-02-18 Repair queued
Att R - OP Depart Patient Record Form.docx Supplementary Document Uploaded 2015-02-18 Available
Att Q - Emer Depart Patient Record Form.docx Supplementary Document Uploaded 2015-02-18 Available
Att M- ERB Approval Notice.pdf Supplementary Document Uploaded 2015-02-18 Available
Att L - Westat Data Security Plan.pdf Supplementary Document Uploaded 2015-02-18 Available
Att E - Amb Intro Letter to Hosp EDs OPDs.docx Supplementary Document Uploaded 2015-02-18 Repair queued
Att D - Introductory Letter to Hospitals.docx Supplementary Document Uploaded 2015-02-18 Repair queued
Att C - NHCS Data Collection Flow Chart.docx Supplementary Document Uploaded 2015-02-18 Repair queued
Att B - Federal Register Notice for NHCS.pdf Supplementary Document Uploaded 2015-02-18 Repair queued
Att A - Legislative Authority.rtf Supplementary Document Uploaded 2015-02-18 Available
0920-0212 SS B 013015.docx Supporting Statement B Uploaded 2015-02-18 Available
IC Document Collections
IC IDCollectionTypeStatusForm
6666 Initial Hospital Intake Questionnaire Form Modified
215050 Prepare and Submit EHR for Inpatient and Ambulatory Instruction New
205650 FSASC Pulling and Refiling Patient Records Instruction Removed
205649 FSASC Prepare and Transmit UB-40 Instruction Removed
205648 Annual FSASC Interview Form Removed
205647 Pulling and re-filing Patient Records (ED, OPD, and ASL) Instruction Removed
186285 Prepare and transmit UB-04 for Inpatient and Ambulatory Instruction Modified
186284 Ambulatory Unit Induction Form Removed
186283 Annual Ambulatory Hospital Interview Other-Interview Modified
186282 Annual Inpatient Hospital Interview Other-Interview Modified
186281 Recruitment Survey Presentation Other-Presentation Modified
ICR Details
0920-0212 201502-0920-011
Historical Inactive 201302-0920-001
HHS/CDC 18672
National Hospital Care Survey
Revision of a currently approved collection   No
Regular
Withdrawn and continue 05/07/2015
Retrieve Notice of Action (NOA) 03/03/2015
Please resubmit with only the average annual burden that will likely be used over the three year clearance period (i.e., the revision will only allow for piloting changes in protocol and sampling, not an extension of the original clearance period.)
  Inventory as of this Action Requested Previously Approved
04/30/2016 36 Months From Approved 04/30/2016
131,516 0 131,516
7,224 0 7,224
0 0 0

The National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), requests approval to continue the National Hospital Care Survey (NHCS) (OMB No. 0920-0212) which integrates the National Hospital Ambulatory Medical Care Survey (NHAMCS) (OMB No. 0920-0278) and the Drug-Abuse Warning Network (DAWN) (OMB No. 0930-0078, expired 12/31/2011) previously conducted by the Substance Abuse and Mental Health Services Administration's (SAMHSA). Integration of NHAMCS and DAWN into the NHCS is part of a broader strategy to improve efficiency by minimizing redundancy in data collection; broadening our capability to collect more relevant data on transitions of care; and identifying opportunities to explore electronic and administrative clinical data systems to augment primary data collection.

US Code: 42 USC 242k Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  78 FR 14709 03/17/2014
79 FR 49517 08/21/2014
No

Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Burden increased overall due to the addition of 81 hospitals to the sample. Burden decreased overall due to removal of several line items, combining of questions, new electronic capabilities and removal of 2 other functions no longer required.

$9,173,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Carol Marsh 404 639-4773 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/03/2015