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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Annual Hospital Interview
Modified
598
1196
0
Form and Instruction
0920-0212
Annual Hospital Interview 2019
Annual Ambulatory Hospital Interview
Removed
0
0
0
Form and Instruction
0920-0212
Att K - Ann Amb Hosp Inter
Initial Hospital Intake Questionnaire
Modified
150
150
0
Form and Instruction
0920-0212
Initial Hospital Intake Questionnaire 2019
Prepare and Transmit EHR for Inpatient and Ambulatory
Modified
796
796
0
Form and Instruction
0920-0212
EHR for Inpatient and Ambulatory (quarterly)
Prepare and transmit UB-04 or State File for Inpatient and Ambulatory
Modified
4788
4788
0
Form and Instruction
0920-0212
UB-04 or State File for Inpatient and Ambulatory (monthly)
Recruitment Survey Presentation
Modified
150
150
0
Form and Instruction
0920-0212
Recruitment Survey Presentation 2019
Total burden requested under this ICR:
6482
7080
0
To view an IC, click on IC Title