Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Economic Indicators Modified 23 23 0 Form 0920-1365 EcoIndicatorCostTool_CoreSIPP
Emergency Department Injury Indicators Modified 26 130 0 Form 0920-1365 ERDEPTInjuryIndicator_CoreSIPP
Hospital Discharge Injury Indicators Modified 26 130 0 Form 0920-1365 HosDischargeInjuryIndicator_CoreSIPP
Implementation Capacity Rubric Modified 26 52 0 Form 0920-1365 ImplementCapRubric_CoreSIPP
Injury Indicators Modified 26 130 0 Form 0920-1365 DeathInjuryIndicator_CoreSIPP
Recipient-level Group Interviews Modified 26 39 0 Form 0920-1365 RECGroupInterview_CoreSIPP
Special Emphasis Reports Modified 26 260 0 Form and Instruction 0920-21GB Special Emphasis Report Examples
Form 0920-1365 SpecialEmphasisRpt_CoreSIPP
Total burden requested under this ICR: 179 764 0  
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