Information Collection

Annual Hospital Interview (Revised)

IC 243666 under ICR 202110-0920-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920 Annual Hospital Interview (Revised) Form
0920 Annual Hospital Interview (revised) Att A - 2020 Annual Hospital Interview (Revised).docx Form
0920 Annual Hospital Interview (revised) Att A - 2020 Annual Hospital Interview (Revised).docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Hospital Interview (Revised)	Agency IC Tracking Number:	0920-0212-20RX

Is this a Common Form? No		IC Status: Removed

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	0920	Annual Hospital Interview (revised)	Att A - 2020 Annual Hospital Interview (Revised).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 598	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-598	598
Annual IC Time Burden (Hours)	-1,196	1,196
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.