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Agenda
Reg Review
ICR
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
To view an IC, click on IC Title