Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Attachment C- Data Use Agreement New 165 8 1148 Form and Instruction 3 Attachment C Data Use Agreement
Attachment D- Data File Emails New 165 165 23694 Form and Instruction 4 Data Submission Emails
Data Files Submission Removed 0 0 0 Form and Instruction Attachment D Data Files Submission
Data Use Agreement Removed 0 0 0 Form and Instruction Form # 2 Attachment B: Hospital Data Use Agreement
Eligibility/Registration Form and Data Submission Removed 0 0 0 Form and Instruction Form # 1 Attachment A: Hospital Eligibility and Registration Form
Hospital Eligibility and Registration Form New 165 8 1148 Form and Instruction 1 Hospital Eligibility and Registration Form
Hospital Information Form Removed 0 0 0 Form and Instruction Form # 3 Attachment C: Hospital Site Information Form
Hospital Site Information New 495 41 5888 Form and Instruction 2 Hospital Site Information
Total burden requested under this ICR: 990 222 31878  
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