Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Hospital Restraint/Seclusion Death Report Worksheet Modified 6225 2054 0 Form and Instruction CMS-10455 Intake
Form and Instruction CMS-10455 Screenshot
Form and Instruction CMS-10455 Health Death Report Form
Total burden requested under this ICR: 6225 2054 0  
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