Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ASC Patient Record Form Modified 5400 630 0 Form unnumbered
Ambulatory Unit Induction Modified 1779 445 0 Instruction
Cervical Cancer Screening Supplement Modified 255 64 0 Form unnumbered
ED Patient Record Form Modified 11300 1318 0 Instruction
Freestanding ASC Induction Form Removed 0 0 0 Instruction
Hospital Induction (new sample) Removed 0 0 0 Instruction
Hospital Induction Form Modified 482 723 0 Form and Instruction none
Medical Record Reabstraction Modified 720 12 0 Instruction
OPD Patient Record Form Modified 15600 3640 0 Instruction
Pretests Removed 0 0 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 97090 1618 0 Instruction
Reabstraction Telephone Call Modified 72 6 0 Instruction
Total burden requested under this ICR: 132698 8456 0  
To view an IC, click on IC Title