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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
Unchanged
598
1196
0
Form and Instruction
0920-0212
Annual Hospital Interview 2019
Annual Hospital Interview (Revised)
New
598
1196
0
Form
0920
Annual Hospital Interview (revised)
Initial Hospital Intake Questionnaire
Unchanged
150
150
0
Form and Instruction
0920-0212
Initial Hospital Intake Questionnaire 2019
National Hospital Care Survey (Abstraction Form)
Unchanged
5
5
0
Form
0920-0212
Validation of Enhanced Algorithms to Identify Opioid Use and Co-Occurring Disorders in National Hospital Care Survey (NHCS)
PCORFIT Telephone Script
Unchanged
25
13
0
Other-WORD
Prepare and Transmit EHR for Inpatient and Ambulatory
Unchanged
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
Unchanged
4788
4788
0
Form and Instruction
0920-0212
UB-04 or State File for Inpatient and Ambulatory (monthly)
Recruitment Survey Presentation
Unchanged
150
150
0
Form and Instruction
0920-0212
Recruitment Survey Presentation 2019
Total burden requested under this ICR:
7110
8294
0
To view an IC, click on IC Title