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 Induction Modified 1946 487 0 Instruction
Cervical Cancer Screening Supplement Modified 255 64 0 Form unnumbered
ED Patient Record Form Modified 15400 1797 0 Instruction
Freestanding ASC Induction Form Modified 200 100 0 Instruction
Hospital Induction (new sample) New 167 84 0 Instruction
Hospital Induction Form Modified 482 723 0 Instruction
OPD Patient Record Form Modified 15600 3640 0 Instruction
Pretests Modified 20 82 0 Form none
Form none
Form none
Form none
Form none
Form none
Form none
Form none
Form none
Pulling and re-filing Patient Records Modified 56525 942 0 Instruction
Total burden requested under this ICR: 111395 9999 0  
To view an IC, click on IC Title