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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Healthcare Facility Assessment (HFA)
Unchanged
500
375
0
Form
none
Healthcare Facility Assessment
Patient Information Form (PIF)
Modified
10500
2975
0
Form
none
Patient Information Form
Provision of patient lists
New
100
400
0
Instruction
Total burden requested under this ICR:
11100
3750
0
To view an IC, click on IC Title
An official website of the United States government
The .gov means it's official.
The site is secure.
