ICR Documents

Supporting Statement A Document Date Uploaded NHCS 2013 - 2015 Supporting Statement Part A__Revised 032713_LM.DOCX 04/15/2013 Supporting Statement B Document Date Uploaded NHCS 2013 - 2015 Supporting Statement Part B Final 0 4 12 13.docx 04/15/2013 Supplementary Documents Title Document Document Type Date Uploaded Att Q - UB-04 Data Elements Attachment Q- List of UB04 Data Elements.docx Supplementary Document 01/31/2013 Att Q - UB-04 Data Elements Attachment Q- List of UB04 Data Elements.docx Supplementary Document 01/31/2013 Att A - Legislative Authority Attachment A - Legislative Authority to Collect Data on Hospital Utilization.rtf Supplementary Document 01/30/2013 Att B - 60 day FRN Attachment B- Federal Register Notice for NHCS.pdf Supplementary Document 01/30/2013 Att C - Hospital Introductory Letter Attachment C- Intro Letter to Hospitals.docx Supplementary Document 01/30/2013 Att D - Ambulatory Introductory Letter Attachment D - Ambulatory Intro Letter to Hospitals EDs OPDs ASLs.docx Supplementary Document 01/30/2013 Att E - FASC Introductory Letter Attachment E- Intro Letter to FSASCs.docx Supplementary Document 01/30/2013 Att F - Data Collection Flowchart Attachment F - Hospital Ambulatory Data Collection Flow Chart.docx Supplementary Document 04/15/2013 Att G - Data Security Plan Attachment G- Westat Data Security Plan .pdf Supplementary Document 01/30/2013 Att H - ERB Approval Attachment H- ERB Approval Notice for NHCS .pdf Supplementary Document 01/30/2013 Att R - ED Patient Record Form Attachment R - ED Patient Record form.docx Supplementary Document 04/15/2013 Att S - Outpatient Dept. Patient Record Form Attachment S - OPD Patient Record form.docx Supplementary Document 01/31/2013 Att T - Ambulatory Surgery Patient Record Form Attachment T - AS Patient Record Form.docx Supplementary Document 01/31/2013 Att U - NHCS FAQ Brochure Attachment U- NHCS FAQ Brochure .pdf Supplementary Document 01/31/2013 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received