Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Use Agreement New 250 13 0 Form and Instruction Form #2 Data Use Agreement
Eligibility/Registration Form and Data Submission New 250 1400 0 Form and Instruction Form #1 Eligibility and Registration Form
Hospital Information Form New 750 63 0 Form and Instruction Form #4 Hospital Information Form
Patient Safety Improvement Initiatives Form New 375 31 0 Form and Instruction Form #3 Patient Safety Improvement Initiatives Form
Total burden requested under this ICR: 1625 1507 0  
To view an IC, click on IC Title