Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
2016 Ambulatory Surgery Center Patient Record Form Modified 2300 268 0 Form and Instruction 0920-0278
Instruction
2016 Emergency Department Patient Record Form Modified 3300 385 0 Form and Instruction 0920-0278
Instruction
2016 Outpatient Department Patient Record Form Modified 4600 1073 0 Form and Instruction 0920-0278
Instruction
Ambulatory Unit Induction Interview Unchanged 1750 438 0 Form and Instruction None
Hospital Induction Interview Modified 458 573 0 Form and Instruction 0920-0278
Instruction
Reabstraction Telephone Call Unchanged 72 6 0 Instruction
Retrieve Medical Records Unchanged 92568 1543 0 Instruction
Retrieve Medical Records Records (Reabstraction) Unchanged 720 12 0 Instruction
Total burden requested under this ICR: 105768 4298 0  
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