Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ASL Patient Record Form Removed 0 0 0 Form none
Ambulatory Surgery Center Patient Record Form New 2300 268 0 Form and Instruction None
Ambulatory Unit Induction Removed 0 0 0 Instruction
Ambulatory Unit Induction Interview New 1750 438 0 Form and Instruction None
ED Patient Record Form Removed 0 0 0 Form none
Emergency Department Patient Record Form New 3300 385 0 Form and Instruction None
Hospital Induction Form Removed 0 0 0 Form none
Hospital Induction Interview New 458 687 0 Form and Instruction None
Medical Record Reabstraction Removed 0 0 0 Instruction
OPD Patient Record Form Removed 0 0 0 Form none
Outpatient Department Patient Record Form New 4600 1073 0 Form and Instruction None
Pulling and re-filing Patient Records Removed 0 0 0 Instruction
Reabstraction Telephone Call Removed 0 0 0 Instruction
Reabstraction Telephone Call New 72 6 0 Instruction
Retrieve Medical Records New 92568 1543 0 Instruction
Retrieve Medical Records Records (Reabstraction) New 720 12 0 Instruction
Total burden requested under this ICR: 105768 4412 0  
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