Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Screening Part A Modified 567 28 0 Form and Instruction 0920-0743 Attachment 4a Screening Part A-English
Form and Instruction 0920-0743 Attachment 4b Screening Part A-Spanish
Screening Part B Modified 1771 59 0 Form and Instruction 0920-0743 Attachment 4c Screening Part B-English
Form and Instruction 0920-0743 Attachment 4d Screening Part B-Spanish
mPINC Hospital Survey Modified 1380 690 0 Form and Instruction 0920-0743 mPINC Hospital Survey- English
Form and Instruction 0920-0743 mPINC Hospital Survey-Spanish
Total burden requested under this ICR: 3718 777 0  
To view an IC, click on IC Title