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
Form none
Ambulatory Unit Record Modified 1827 1827 0 Form unnumbered
Form none
Form none
Asthma Management Supplement New 12 3 0 Form none
Cervical Cancer Screening Supplement Modified 255 64 0 Form unnumbered
ED Patient Record Form Modified 22500 2625 0 Form unnumbered
Form none
Freestanding ASC Induction Form Modified 208 312 0 Form none
Form none
Form none
Hospital Induction Form Modified 494 494 0 Form none
Form none
Form none
OPD Patient Record Form Modified 25600 3840 0 Form none
Form none
Form none
Pulling and Refiling Patient Records Pretest New 400 7 0 Instruction
Pulling and re-filing Patient Records Modified 56525 942 0 Instruction
Total burden requested under this ICR: 128621 12194 0  
To view an IC, click on IC Title