Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Use Agreement Modified 304 15 0 Form and Instruction Form # 2 Attachment B: Hospital Data Use Agreement
Eligibility/Registration Form and Data Submission Modified 304 319 0 Form and Instruction Form # 1 Attachment A: Hospital Eligibility and Registration Form
Hospital Information Form Modified 912 76 0 Form and Instruction Form # 3 Attachment C: Hospital Site Information Form
Total burden requested under this ICR: 1520 410 0  
To view an IC, click on IC Title