Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ASC Patient Record Form Modified 20800 2080 0 Form unnumbered
Ambulatory Unit Record Modified 1779 1779 0 Form unnumbered
Form none
Cervical Cancer Screening Supplement Modified 255 64 0 Form unnumbered
ED Patient Record Form Modified 22500 2625 0 Form unnumbered
Freestanding ASC Induction Form Modified 200 300 0 Form none
Form none
Hospital Induction Form Modified 482 482 0 Form none
Form none
OPD Patient Record Form Modified 25600 3840 0 Form none
Form none
Pulling and re-filing Patient Records Modified 56525 942 0 Instruction
Total burden requested under this ICR: 128141 12112 0  
To view an IC, click on IC Title