Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Files Submission Modified 340 340 0 Form and Instruction Attachment D Data Files Submission
Data Use Agreement Modified 340 17 0 Form and Instruction Form # 2 Attachment B: Hospital Data Use Agreement
Eligibility/Registration Form and Data Submission Modified 340 17 0 Form and Instruction Form # 1 Attachment A: Hospital Eligibility and Registration Form
Hospital Information Form Modified 1020 85 0 Form and Instruction Form # 3 Attachment C: Hospital Site Information Form
Total burden requested under this ICR: 2040 459 0  
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