Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual Hospital Interview Unchanged 598 1196 0 Form and Instruction 0920-0212
Initial Hospital Intake Questionnaire Unchanged 150 150 0 Form and Instruction 0920-0212
National Hospital Care Survey (Abstraction Form) New 5 5 0 Form 0920-0212
PCORFIT Telephone Script New 25 13 0 Other-WORD
Prepare and Transmit EHR for Inpatient and Ambulatory Unchanged 796 796 0 Form and Instruction 0920-0212
Prepare and transmit UB-04 or State File for Inpatient and Ambulatory Unchanged 4788 4788 0 Form and Instruction 0920-0212
Recruitment Survey Presentation Unchanged 150 150 0 Form and Instruction 0920-0212
Total burden requested under this ICR: 6512 7098 0  
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