Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual Hospital Interview Modified 598 1196 0 Form and Instruction 0920-0212
Annual Ambulatory Hospital Interview Removed 0 0 0 Form and Instruction 0920-0212
Initial Hospital Intake Questionnaire Modified 150 150 0 Form and Instruction 0920-0212
Prepare and Transmit EHR for Inpatient and Ambulatory Modified 796 796 0 Form and Instruction 0920-0212
Prepare and transmit UB-04 or State File for Inpatient and Ambulatory Modified 4788 4788 0 Form and Instruction 0920-0212
Recruitment Survey Presentation Modified 150 150 0 Form and Instruction 0920-0212
Total burden requested under this ICR: 6482 7080 0  
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