National Hospital Care Survey

OMB 0920-0212

This request is for a nonsubstantive change to the approved data collection for the National Hospital Care Survey (NHCS) (OMB No. 0920-0212, expiration date: 3/31/2022). The change is to allow the addition of six new survey questions related to the novel coronavirus disease (COVID-19) to the NHCS Annual Hospital Interview (AHI). These questions will be added as soon as possible to the 2020 NHCS and will continue to be included in future years of NHCS, if data collection on COVID-19 remains applicable. The questions will help provide an understanding on experiences of the provision of health care by hospitals during the ongoing COVID-19 pandemic in the United States. .

The latest form for National Hospital Care Survey expires 2022-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-0212 Initial Hospital Intake Questionnaire Form and Instruction
Form 0920 Annual Hospital Interview (Revised) Form
Form 0920-0212 National Hospital Care Survey (Abstraction Form) Form
Form 0920-0212 Prepare and Transmit EHR for Inpatient and Ambulatory Form and Instruction
Form 0920-0212 Annual Hospital Interview Form and Instruction
Form 0920-0212 Prepare and transmit UB-04 or State File for Inpatient and Ambulatory Form and Instruction
Form 0920-0212 Recruitment Survey Presentation Form and Instruction
NHCS-30day-FRN_08.27.2021.docx Supplementary Document
Att M - Proposed Confidentiality Letter.docx Supplementary Document
Att J - Recruitment Survey Presentation.docx Supplementary Document
Att H - ERB Approval Notice for NHCS.pdf Supplementary Document
Att G - EHR Variable List.xlsx Supplementary Document
Att F - Currently Approved UB04 Data Elements.docx Supplementary Document
Att E - NHCS Overview Flyer.docx Supplementary Document
Att E - NHCS Overview Flyer.docx Supplementary Document
Att D - NHCS Introductory Letter.pdf Supplementary Document
Att A - Legislative Authority to Collect Data on Hospital Utilization.rtf Supplementary Document
0920-0212_Statement A_COVID-nonsub_09.08.2020.docx Supplementary Document
COVID-19 OMB Memo_NHCS.docx Justification for No Material/Nonsubstantive Change
Nonsubstantive Change PCORTF_Opioid_04_08_2020 SK.docx Justification for No Material/Nonsubstantive Change
Att M - Summary Update.docx Supplementary Document
Att K - Confidentiality Letter.docx Supplementary Document
Att G - ERB Approval Notice for NHCS.pdf Supplementary Document
Att E- EHR Variable List.pdf Supplementary Document
Att D - Currently Approved UB04 Data Elements.docx Supplementary Document
Att C - Introductory Letter to Hospitals.docx Supplementary Document
Att B2 - 60-day Federal Register Notice Comments.docx Supplementary Document
Att B1- 60-Day FRN for NHCS 120718.pdf Supplementary Document
Att A - Legislative Authority to Collect Data on Hospital Utilization.rtf Supplementary Document
0920-0212_Statement B_06.28.2021.docx Supporting Statement B
0920-0212_Statement A_07.01.2021.docx Supporting Statement A
Initial Hospital Intake Questionnaire Form and Instruction
Annual Hospital Interview (Revised) Form
PCORFIT Telephone Script Other-WORD
National Hospital Care Survey (Abstraction Form) Form
Prepare and Transmit EHR for Inpatient and Ambulatory Form and Instruction
Annual Hospital Interview Form and Instruction
Prepare and transmit UB-04 or State File for Inpatient and Ambulatory Form and Instruction
Recruitment Survey Presentation Form and Instruction

All Historical Document Collections

202110-0920-008 Approved without change	Revision of a currently approved collection	2021-11-04
202009-0920-013 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-09-17
202003-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-04-30
201901-0920-008 Approved without change	Revision of a currently approved collection	2019-01-30
201511-0920-007 Approved without change	Revision of a currently approved collection	2015-11-19
201502-0920-011 Withdrawn and continue	Revision of a currently approved collection	2015-03-03
201408-0920-007 Withdrawn and continue	Revision of a currently approved collection	2014-09-12
201302-0920-001 Approved without change	Revision of a currently approved collection	2013-02-01
201104-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-04-14
201102-0920-003 Approved without change	Revision of a currently approved collection	2011-02-01
200909-0920-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2009-09-14
200808-0920-008 Approved without change	Revision of a currently approved collection	2008-08-26
200802-0920-014 Approved without change	No material or nonsubstantive change to a currently approved collection	2008-02-25
200612-0920-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2006-12-12
200507-0920-002 Approved without change	Revision of a currently approved collection	2005-07-12
200207-0920-001 Approved with change	Extension without change of a currently approved collection	2002-07-10
200011-0920-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2000-11-09
199909-0920-003 Approved without change	Extension without change of a currently approved collection	1999-09-07
199611-0920-001 Approved without change	Extension without change of a currently approved collection	1996-11-18
199511-0920-003 Approved without change	Extension without change of a currently approved collection	1995-11-29
199211-0920-001 Approved without change	Revision of a currently approved collection	1992-11-16
199006-0920-002 Approved without change	Revision of a currently approved collection	1990-06-27
198905-0920-011 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-05-04
198904-0920-025 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-27
198904-0920-018 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-06
198904-0920-015 Approved with change	No material or nonsubstantive change to a currently approved collection	1989-04-07
198802-0920-006 Approved without change	Revision of a currently approved collection	1988-02-05

OMB Details

Initial Hospital Intake Questionnaire

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 0920-0212

Initial Hospital Intake Questionnaire 2019

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.