Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Annual Hospital Interview Modified 608 1216 0 Form and Instruction 0920-0212
Annual Hospital Interview (Revised) Removed 0 0 0 Form 0920
Initial Hospital Intake Questionnaire Modified 150 136 0 Form and Instruction 0920-0212
National Hospital Care Survey (Abstraction Form) Removed 0 0 0 Form 0920-0212
PCORFIT Telephone Script Removed 0 0 0 Other-WORD
Prepare and Transmit EHR for Inpatient and Ambulatory Modified 800 800 0 Form and Instruction 0920-0212
Prepare and transmit UB-04 or State File for Inpatient and Ambulatory Modified 4896 4896 0 Form and Instruction 0920-0212
Recruitment Survey Presentation Modified 150 136 0 Form and Instruction 0920-0212
Total burden requested under this ICR: 6604 7184 0  
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