Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Attestation Form Removed 0 0 0 Form and Instruction Form #7
Certification for Continued Listing Form Modified 24 192 0 Form and Instruction Form #2
Common Formats Modified 750 75000 0 Form and Instruction Form #7
Disclosure Form - Revised Modified 7 21 0 Form and Instruction Form #4
Information Form - Revised Modified 80 240 0 Form and Instruction Form #5
Patient Safety Confidentiality Complaint Form New 3 1 0 Form and Instruction Form #6
Patient Safety Organization Certification for Initial Listing Form Modified 15 270 0 Form and Instruction Form #1
Two Bona Fide Contracts Requirement Form Modified 40 40 0 Form and Instruction Form #3
Total burden requested under this ICR: 919 75764 0  
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