Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Ancillary Service Executive/Ambulatory Unit Induction (OPD) Modified 956 956 0 Instruction
Ancillary Service Executive/Hospital Induction Pandemic and Emergency Response Preparedness Questions Modified 455 190 0 Instruction
Hospital Chief Medical Officer/Ancillary Service Executive/Hospital Induction/Ambulatory Unit Induction (ED) Modified 820 820 0 Instruction
Hospital Chief Medical Officer/Physician Assistant/Nurse Practitioner Hospital Induction(Ineligible)/Cervical Cancer Screening Supplement Modified 300 75 0 Instruction
Medical Record Clerk/ Pulling and re-filing ED Patient Record Modified 18000 300 0 Instruction
Medical Record Clerk/ Pulling and re-filing OPD Patient Record Modified 23750 396 0 Instruction
Physcian/Registered Nurse Medical Record Clerk ED Patient Record Form Modified 22000 2200 0 Instruction
Physician/ Registered Nurse/Medical Record Clerk OPD Patient Record Form Modified 23750 2375 0 Instruction
Total burden requested under this ICR: 90031 7312 0  
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