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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
MHDS - 2010 & 2011 Survey Presentation to Hospitals
New
80
80
0
Other-2010 & 2011 Survey Presentation to Hospitals
NHDS - 2010 & 2011 Facility Questionnaire
New
80
320
0
Other-Facility Questionnaire
NHDS - 2010 & 2011 Sample listing sheet
New
19200
4480
0
Other-2010 & 2011 Sample listing sheet
NHDS - 2010 & 2011 Verify Sampling and Reabstract
New
75
18
0
Other-2010 & 2011 Verify Sample and Reabstraction
NHDS - Alternate Procedure Hospitals Locating Medical Records Manual
New
10250
171
0
Other-Attachment G4 - Hospital Manual
NHDS - Hospital In-house Tape or Printout Transmittal Notice
New
348
75
0
Other-Attachment G5 - Hospital In-house Tape or Printout Transmittal Notice
NHDS - Hospital Interview Questionnaire
New
10
20
0
Other-Hospital Interview Questionnaire
NHDS - Medical abstract form
Modified
3250
271
0
Other-Medical Abstract Form
NHDS - Pretest Debrief Hospital Staff Guide
New
10
10
0
Other-Pretest Debrief Hospital Staff Guide
NHDS - Pretest Facility Questionnaire
New
10
40
0
Other-Pretest Facililty Questionnaire
NHDS - Pretest Sample Listing Sheet
New
100
23
0
Other-Pretest Sample Listing Sheet
NHDS - Pretest Survey Presentation
New
10
10
0
Other-Survey Presentation for Pretest
NHDS - Pretest Verify Sampling and Reabstract
New
20
5
0
Other-Pretest Verify Sampling and Reabstract
NHDS - Primary Procedure Hospitals Sample Listing Sheet
New
156
65
0
Other-Primary Procedures Hospitals Sampling Listing Sheet
NHDS - Primary Procedures Hospital Transmittal Notice
New
156
3
0
Other-Primary Procedures Hospitals Transmittal Notice
Total burden requested under this ICR:
33755
5591
0
To view an IC, click on IC Title